摘要
目的分析呼出气一氧化氮(FeNO)测定在支气管哮喘诊治中的应用价值。方法选取2017年10月~2018年10月于解放军陆军第958医院就诊的120例支气管哮喘患者。完成呼出气一氧化氮测定和支气管激发试验后,将其中符合纳入标准的慢性持续期患者分为FeNO指导组和常规组,FeNO指导组结合《全球哮喘防治创议(2016)》推荐治疗方案和FeNO最佳截断值指导降阶梯治疗,常规组不采用FeNO指导降阶梯治疗。比较支气管激发试验与FeNO对支气管哮喘诊断价值;比较FeNO指导组、常规组两组患者6个月内降阶梯治疗失败率,以及3个月、6个月时临床完全控制率和药物剂量。结果共97例患者符合慢性持续期标准,剔除失访,完成研究的FeNO指导组46例、常规组47例。ROC曲线下FeNO截断值为27.1 ppb,FeNO的ROC曲线下面积AUC为0.716,低于支气管激发试验AUC的0.869,FeNO对支气管哮喘诊断价值低于支气管激发试验,差异有统计学意义(P<0.05)。按FeNO最佳截断值27.1 ppb指导降阶梯治疗,治疗期间FeNO指导组共有61例次降阶梯治疗,其中5例次(8.19%)降阶梯治疗失败;常规组共有70例次降阶梯治疗,其中15例次(21.43%)治疗失败,两组患者降阶梯治疗失败率比较差异有统计学意义(χ2=4.412,P<0.05)。两组患者各时点临床完全控制率比较,差异无统计学意义(P>0.05)。治疗4~6个月时,FeNO指导组吸入性糖皮质激素、缓解药物剂量均低于常规组,差异有统计学意义(P<0.05)。结论FeNO对评估支气管哮喘患者病情以及指导临床治疗均有一定价值。
Objective To analyze the application effects of exhaled nitric oxide in diagnosis and treatment of bronchial asthma.Methods Firstly,120 patients with bronchial asthma were selected from October 2017 to October 2018.The measurement of exhaled nitric oxide and bronchial provocation test were completed.After that,the patients that were dialoged with chronic persistent patients were divided two groups:the FeNO guidance group and the convention group.The patients in the FeNO guidance group were given FeNO treatment guided by the Global Asthma Prevention and Treatment Initiative(2016),while the patients in the conventional group did not use FeNO treatment.The correlation of FeNO with EOS,N and IgE was analyzed.To compare the diagnostic value of bronchial provocation test and FeNO in bronchial asthma;to compare the failure rate of ladder reduction treatment within 6 months,and the clinical complete control rate and drug dosage at 3 months and 6 months in FeNO Guidance Group and routine group.Results97 patients met the standard,Eliminate lost visitors and there were 46 cases in FeNO steering group and 47 cases in convention group.There was no correlation between FeNO and EOS,N and IgE(P>0.05).The cutoff value of FeNO under ROC curve was 27.1 ppb,AUC under ROC curve of FeNO was 0.716,lower than 0.869 of bronchial provocation test’AUC,and the diagnostic value of FeNO for bronchial asthma was lower than that of bronchial provocation test(P<0.05).According to the best cutoff value of FeNO27.1 ppb,61 patients in the observation group were treated with ladder reduction,5 of them(8.19%)failed in ladder reduction;70 patients in the convention group were treated with ladder reduction,15 of them(21.43%).There was a significant difference between the two groups in the failure rate of step-down therapy(x2=4.412,P<0.05).There was no significant difference in clinical complete control rate between the two groups(P>0.05).At 4-6 months,the inhaled glucocorticoid and the dose of relieving drugs in FeNO guidance group were lower than those in the convention group,the difference was statistically significant(P<0.05).Conclusion FeNO has certain value in evaluating the condition of patients with asthma and guiding clinical treatment.
作者
邓彬兵
李涛
Deng Binbing;Li Tao(Department of Respiratory and Critical Care Medicine,958 Hospital of PLA Army,Chongqing 400020,China)
出处
《中华保健医学杂志》
2020年第2期116-119,共4页
Chinese Journal of Health Care and Medicine
关键词
支气管哮喘
呼出气一氧化氮
气道炎症
肺功能
Bronchial asthma
Exhaled nitric oxide
Airway inflammation
Lung function
