引用本文:范龙梅,孟 耸,张 威,韩国敬.FeNO联合小气道功能指标对哮喘患者气道高反应性的诊断效能分析[J].中国临床新医学,2022,15(8):733-737.
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FeNO联合小气道功能指标对哮喘患者气道高反应性的诊断效能分析
范龙梅,孟 耸,张 威,韩国敬
100036 北京,北京市羊坊店医院内科(范龙梅);100853 北京,解放军总医院第一医学中心呼吸与危重症科(孟 耸,张 威,韩国敬)
摘要:
[摘要] 目的 分析呼出气一氧化氮(FeNO)联合小气道功能指标对哮喘患者气道高反应性(AHR)的诊断效能。方法 选择2019年9月至2022年3月解放军总医院第一医学中心呼吸与危重症科收治的哮喘初诊患者60例。其中支气管舒张试验(BDT)阳性患者30例(BDT阳性组);BDT阴性,而支气管激发试验(BPT)阳性患者30例(BPT阳性组)。另选取同时期有哮喘相关症状,但BDT及BPT均为阴性的非哮喘者30例(对照组)。比较三组的一般临床资料,以及FeNO、第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC%)、用力肺活量占预计值百分比(FVC%pred)、用力呼气50%肺活量的瞬间流量占预计值百分比(FEF50%pred)、用力呼气75%肺活量的瞬间流量占预计值百分比(FEF75%pred)、最大呼气中期流量占预计值百分比(MMEF%pred)水平。采用受试者工作特征(ROC)曲线法分析FeNO及小气道功能指标诊断AHR的效能。结果 BDT阳性组和BPT阳性组的FeNO水平显著高于对照组(P<0.05),但BDT阳性组和BPT阳性组比较差异无统计学意义(P>0.05)。BDT阳性组和BPT阳性组的MMEF%pred、FEF75%pred、FEF50%pred水平低于对照组,小气道功能障碍发生率高于对照组,差异有统计学意义(P<0.05),但BDT阳性组和BPT阳性组比较差异无统计学意义(P>0.05)。ROC曲线分析结果显示,FeNO、FEF50%pred、FEF75%pred和MMEF%pred均具有诊断AHR的效能(P<0.05),且FeNO联合小气道功能指标可进一步提高诊断效能,其中以FeNO+FEF50%pred的诊断效能最佳[AUC(95%CI):0.868(0.780~0.956)],灵敏度为86.70%,特异度为73.30%。结论  FeNO联合小气道功能指标能有效诊断哮喘患者AHR,可作为早期轻症哮喘诊断的补充工具。
关键词:  哮喘  呼出气一氧化氮  小气道功能指标  气道高反应性  诊断价值
DOI:10.3969/j.issn.1674-3806.2022.08.13
分类号:R 562.2
基金项目:
Analysis on the diagnostic efficacy of FeNO combined with small airway function indicators for airway hyperresponsiveness in asthma patients
FAN Long-mei, MENG Song, ZHANG Wei, et al.
Department of Internal Medicine, Beijing Yangfangdian Hospital, Beijing 100036, China
Abstract:
[Abstract] Objective To analyze the diagnostic efficacy of fractional exhaled nitric oxide(FeNO) combined with small airway function indicators in the diagnosis of airway hyperresponsiveness(AHR) in patients with asthma. Methods Sixty newly diagnosed asthma patients who were admitted to the Department of Respiratory and Critical Care Medicine, the First Medical Center, Chinese People′s Liberation Army General Hospital from September 2019 to March 2022 were selected. Among them, 30 patients were positive for bronchial dilation test(BDT)(BDT-positive group); 30 patients were BDT-negative and bronchial provocation test(BPT)-positive(BPT-positive group). In addition, 30 non-asthmatic patients who had asthma-related symptoms during the same period but were negative for BDT and BPT were selected as the control group. The general clinical data were compared among the three groups, as well as the level of FeNO, percentage of forced expiratory volume in the first second to the expected value(FEV1%pred), percentage of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC%), predicted forced vital capacity(FVC%pred), percentage of 50% forced expiratory flow to the expected value(FEF50%pred), percentage of 75% forced expiratory flow to the expected value(FEF75%pred) and percentage of maximal mid-expiratory flow to the expected value(MMEF%pred). The receiver operator characteristic(ROC) curve method was used to analyze the efficacy of FeNO and small airway function indicators in diagnosing AHR. Results The levels of FeNO in the BDT-positive group and the BPT-positive group were significantly higher than those in the control group(P<0.05), but there was no significant difference in the level of FeNO between the BDT-positive group and the BPT-positive group(P>0.05). The levels of MMEF%pred, FEF75%pred, and FEF50%pred in the BDT-positive group and the BPT-positive group were lower than those in the control group, and the incidence rates of small airway dysfunction in the BDT-positive group and the BPT-positive group were higher than those in the control group, and the differences were statistically significant(P<0.05). However, there were no significant differences in the above indicators between the BDT-positive group and the BPT-positive group(P>0.05). The results of ROC curve analysis showed that FeNO, FEF50%pred, FEF75%pred and MMEF%pred all had efficacy in diagnosing AHR(P<0.05). In addition, FeNO combined with small airway function indicators could further improve the diagnostic efficacy. Among them, FeNO+FEF50%pred had the best diagnostic efficiency[AUC(95%CI): 0.868(0.780-0.956) ], with a sensitivity of 86.70% and a specificity of 73.30%. Conclusion FeNO combined with small airway function indicators can effectively diagnose AHR in patients with asthma, and can be used as a supplementary tool for early diagnosis of mild asthma.
Key words:  Asthma  Fractional exhaled nitric oxide(FeNO)  Small airway function indicators  Airway hyperresponsiveness(AHR)  Diagnostic value