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支气管哮喘患者呼出气一氧化氮与小气道功能的相关性及影响因素研究
Correlation between Fractional Exhaled Nitric Oxide and Small Airway Function in Patients with Bronchial Asthma and Its Influencing Factors
- DOI:
- 作者:
- 张雪
Zhang Xue
- 作者单位:
- 上海市第一人民医院
The General Hospital of Shanghai Jiao Tong University
- 关键词:
- 支气管哮喘；呼出气一氧化氮；小气道功能障碍；肺功能检测
Bronchial asthma; Fractional exhaled nitric oxide; Small airway dysfunction; Impulse oscillometry
- 摘要:
- 目的： 探讨初次诊断成人支气管哮喘(简称哮喘)患者呼出气一氧化氮（FeNO）与小气道功能间的相关性及吸烟、过敏性鼻炎和体重指数对FeNO的影响。
方法： 2016年9月1日至11月30日于上海市第一人民医院呼吸科门诊就诊的成人哮喘患者，按入选和排除标准纳入受试者42例，同时检测FeNO与肺功能，分析FeNO与小气道功能的相关性，以及吸烟、过敏性鼻炎和体重指数对FeNO的影响。
结果： 42例哮喘患者FeNO和Eos%、MMEF、FEV1%pred呈显著正相关（r=0.433, P=0.004; r=0.399, P=0.009; r=0.315, P=0.043）；与R5-R20无统计学意义相关性；MMEF与R5-R20呈显著负相关（r=-0.500 , P=0.001）。其中16例合并过敏性鼻炎哮喘患者FeNO与Eos%呈显著正相关（r=0.585, P=0.002），26例非过敏性鼻炎的哮喘患者FeNO与FEV1、MMEF有统计学意义正相关（分别为r=0.505, P= 0.009; r=0.431 , P=0.030）。14例吸烟哮喘患者FeNO与肺功能、小气道功能各指标均无统计学意义相关（P>0.05），28例非吸烟哮喘患者FeNO与Eos%、FEV1、MMEF均具正相关（分别r=0.562, P=0.002; r=0.572, P=0.002; r=0.485, P=0.009），而与R5-R20呈负相关趋势，但无统计学意义。体重指数超重组与正常组间FeNO值比较无统计学意义差别。不同指标诊断哮喘小气道功能异常的预测价值：FeNO联合MMEF>FeNO联合R5-R20>R5-R20>FeNO。
结论： 哮喘患者FeNO水平对评估哮喘患者小气道功能障碍有一定临床价值，结合MMEF评价意义更高；FeNO水平在非吸烟及未合并过敏性鼻炎的患者中更有诊断意义，而体重指数对FeNO诊断水平无明显影响。
Objective To explore the correlation between the Fractional exhaled nitric oxide (FeNO) and small airway function in adults with asthma at first diagnosis and the effects of smoking, allergic rhinitis and body mass index(BMI) on FeNO.
Methods Adult asthmatic patients were admitted to Shanghai General Hospital from September 1, 2016 to November 30, 2016. According to the inclusion and exclusion criteria, a total of 42 patients were enrolled in this study. And their FeNO and pulmonary function was detected. Then we analyzed the relationship between FeNO and small airway function and the effects of smoking, allergic rhinitis and BMI on FeNO.
Results There was a significant positive correlation between FeNO and Eos%、MMEF and FEV1%pred (r=0.433, P=0.004; r=0.399, P=0.009; r=0.315, P=0.043) in all 42 asthmatic patients, but not found statistical significance relationship with R5-R20(P>0.05). Also a significant negative correlation between MMEF and R5-R20 was found in all 42 asthmatic patients (r=-0.501, P=0.001). There was a significant positive correlation between FeNO and Eos% (r=0.585, P=0.002) in asthmatic patients with allergic rhinitis and a statistically positive significant correlation between FENO and FEV1, MMEF (r=0.505, P=0.009; r=0.431, P=0.027) in asthmatic patients without allergic rhinitis. There was all no significant correlation between FeNO and lung function and small airway function in 14 smoking asthmatic patients(P>0.05). But a significant positive correlation between FeNO and Eos%、FEV1、MMEF was found in 28 non-smoking asthmatic patients (r=0.562, P=0.002; r=0.572, P=0.002; r=0.485, P=0.009), and a negative correlation trend between FeNO and R5-R20 in these patients. Besides, according to the BMI, no significant difference was found between the over-weight group and the normal group. The predictive value of different indexes in the diagnosis of small airway dysfunction in asthma was: FeNO combined with MMEF> FeNO combined with R5-R20> R5-R20> FeNO.
Conclusion FeNO levels have a certain clinical value in assessing small airway dysfunction in asthmatic patients, and the evaluation is more valuable with MMEF. In addition, FeNO levels in non-smoking and unassociated allergic rhinitis asthmatic patients have more diagnostic significance. In addition, BMI had no significant effect on the diagnostic level of FeNO.
