呼出气一氧化氮在支气管哮喘- 慢性阻塞性 肺疾病重叠诊治中的应用价值

Value of exhaled nitric oxide in the diagnosis and treatment of asthma-COPD overlap syndrome

摘要:

目的 探讨呼出气一氧化氮（FeNO）在哮喘- 慢性阻塞性肺疾病重叠（ACO）诊疗的应用价 值。方法 选取2018 年1 月—2018 年12 月天津医科大学第二医院呼吸内科收治的ACO、哮喘及慢性阻塞 性肺疾病（COPD）患者共171 例作为研究对象。其中，ACO 患者41 例（ACO 组），哮喘患者44 例（哮喘 组），COPD 患者86 例（COPD 组）。选取同期该院健康体检者45 例作为对照组。分析4 组临床特征、外周 血指标、FeNO 及肺功能指标[ 第1 秒最大呼气量（FEV1）、用力肺活量（FVC）、第1 秒最大呼气量/ 预计 值（FEV1%pred）及第1 秒最大呼气量/ 用力肺活量（FEV1/FVC）] 的差异，以及FeNO 与肺功能及外周血指 标的关系。结果 哮喘组年龄低于COPD 组及ACO 组（P <0.05）。ACO 组外周血EOS％、FeNO 水平低于 哮喘组，而高于COPD 组（P <0.05）。ACO 组和哮喘组FeNO 与外周血EOS％水平呈正相关（r s =0.383 和 0.316，P =0.044 和0.037）。COPD 组和ACO 组的FEV1、FVC、FEV1%pred 及FEV1/FVC 低于哮喘组（P <0.05）。 结论 FeNO 和外周血EOS% 对ACO 诊断具有重要的参考价值，与肺功能联合应用有助于ACO 的诊断。

Abstract:

Objective To explore the value of exhaled nitric oxide (FeNO) in the diagnosis and treatment of in asthma-chronic obstructive pulmonary disease overlap syndrome(ACO). Methods A total of 171 patients were enrolled in this study, including 44 patients with asthma, 86 patients with chronic obstructive pulmonary disease (COPD) and 41 patients with ACO. 45 healthy subjects were selected as the control group. The differences of clinical characteristics, peripheral blood indexes, FeNO and pulmonary function include maximum expiratory volume in the first second (FEV1), forced vital capacity (FVC), maximum expiratory volume in the first second/ predicted value (FEV1% pred), maximum expiratory volume in the first second/forced vital capacity(FEV1/FVC) among the four groups were analyzed. And the relationship between FeNO and pulmonary function, peripheral blood indexes was analyzed. Results The age composition of asthma group was lower than that of COPD group and ACO group (P < 0.05). The levels of EOS% in peripheral blood and FeNO of ACO group were lower than those in asthma group but higher than those in COPD group (P < 0.05). There was a positive correlation between FeNO and the level of EOS% in peripheral blood in ACO group and asthma group (r s = 0.383 and 0.316, P < 0.05). The levels of FEV1, FVC, FEV1/% pred, FEV1/FVC in COPD group and ACO group were lower than those in asthma group (P < 0.05). Conclusion FeNO and peripheral blood EOS% have important reference value for the diagnosis of ACO. Combination with pulmonary function is helpful in the diagnosis of ACO.