呼出气一氧化氮浓度检测在儿童咳嗽变异性哮喘中的应用

目的 探讨FeNO检测在儿童咳嗽变异性哮喘中的临床价值。方法 选择2016年3月~2017年3月在我院确诊为CVA的患儿80例及健康儿童40例作为研究对象,比较两组儿童FeNO水平,比较FeNO正常的CVA患儿与FeNO升高患儿的皮肤点刺结果、肺功能,分析CVA患儿FeNO水平与肺功能的相关性。结果 CVA患儿FeNO水平高于健康儿童,差异有统计学意义（P＜0.05）。同FeNO正常的CVA患儿相比,FeNO升高的CVA患儿拥有更高的体重指数,皮肤点刺阳性率更高,强度更强,差异有统计学意义（P＜0.05）,但两组患儿肺功能无统计学差异,CVA患儿FeNO水平与肺功能无相关性（P＞0.05）。结论 FeNO可以辅助诊断CVA,但不能作为评估病情严重程度的指标。     

哮喘缓解期儿童呼出气一氧化氮水平与肺功能的相关性研究及临床意义

目的 探讨处于临床缓解期哮喘儿童呼出气一氧化氮(FeNO)水平与肺功能的相关性.方法 选取2012年1月至2012年11月于成都市妇女儿童中心医院哮喘门诊就诊的处于稳定期的哮喘患儿267例为研究对象,分别测定其FeNO水平和肺功能,分析FeNO水平和肺功能的相关性.结果 处于哮喘缓解期男性儿童与女性儿童FeNO值差异无统计学差异(P＞0.05).FeNO与身高、体重、年龄呈正相关(r =0.213、0.147、0.276,P=0.001、0.025、0.000).与FEF25％、FEF50％、FEF75％各占预计值呈负相关(r=-0.147、-0.127、-0.127、P=0.001 7、0.04、0.04).结论 FeNO水平与肺功能对临床缓解期哮喘儿童小气道的监测有一定的相关性,可将FeNO纳入哮喘管理的一个监测指标.     

呼出气一氧化氮在成人支气管哮喘诊治中的应用

呼出气一氧化氮是当下的非常重要的医疗监测技术,该项技术的优势在于无创性、便捷性,它能够有效的测定患者气道炎症的严重程度、病情发展趋势,为临床治疗提供足够的数据参考。另外,相对于其他技术而言,呼出气一氧化氮的临床可行性比较高,能够对成人支气管哮喘的诊断、治疗提供较大帮助,医疗人员可根据测定结果,与患者的临床症状相结合,①深入了解病因,②制定针对性的治疗方案,为患者的康复做好充分准备,减少发病频率。本研究主要对呼出气一氧化氮在成人支气管哮喘诊治中的应用进行讨论,做出如下综述。     

成人哮喘患者Treg/Th17细胞失衡与呼出气一氧化氮的相关性研究

目的:探讨成人哮喘患者Treg/Th17细胞失衡与呼出气一氧化氮(FeNO)的相关关系。方法:募集成人哮喘患者17例,慢性咳嗽非哮喘患者16例。所有患者均检测FeNO值,并用ELISA法检测血浆IL-17的表达水平,流式细胞术检测外周血中Treg、Th17细胞占CD4~+T淋巴细胞比例。比较两组患者FeNO水平的差异及其与Treg/Th17的相关关系。结果:与慢性咳嗽组相比,哮喘组血浆IL-17浓度升高(P<0.05)、外周血Th17/CD4~+T细胞比值升高(P<0.001)、FeNO水平升高(P<0.001)、Treg/Th17细胞的比值降低(P<0.001),而Treg/CD4~+细胞比值无明显变化(P>0.05)。哮喘组FeNO值与外周血Treg/CD4~+T细胞比值无明显相关性,而与Th17细胞占CD4~+T淋巴细胞比例呈正相关(r=0.663,P=0.01),与Treg/Th17细胞比值呈负相关(r=-0.757,P=0.002)。结论:哮喘患者FeNO水平升高与Treg/Th17失衡有关,主要与Th17细胞表达升高有关。     

呼出气冷凝液标本用于检测运动时气道的健康状况

背景：运动是造成气道高水平氧化应激的重要诱因,精英运动员运动性哮喘和运动性支气管狭窄的发生与气道炎症有关。在运动和运动医学中,准确监测各种心理生理应激后的体内平衡扰动是必不可少的,探索非侵入性收集和分析生物标记物的方法,能够提供关于运动诱发的生理和心理应激的准确信息,显然具有重要的现实意义。目的：梳理总结使用呼出气冷凝液检测识别气道在激烈运动、比赛、过度训练时氧化应激水平、炎症反应程度及酸碱度的变化特征。方法：以“呼出气冷凝液,运动”“气道,氧化应激”“气道,炎症反应”“运动性支气管狭窄”“运动性哮喘”“exhaled breath condensate,exercise”“airway inflammation”“airway oxidative stress”“exercise-induced bronchoconstriction,EIB”“exercise-induced asthma,EIA”等关键词,在中国知网、百度学术、PubMed等数据库,检索1980年6月至2022年9月国内外有关检测健康人和呼吸系统疾病患者运动时气道健康状况的呼出气冷凝液中生物标志物应用的相关文献,...     

慢性阻塞性肺疾病患者不规则趋化因子、白三烯B4及呼出气一氧化氮水平变化及其临床意义

目的 探究慢性阻塞性肺疾病(COPD)患者不规则趋化因子(FKN)、白三烯B4(LTB4)及呼出气一氧化氮(FeNO)水平变化及其临床意义.方法 选择2019年4月至2020年4月在我院就诊的120例COPD患者,另选取同期健康体检者60例作为对照组,按病情严重程度将120例患者分为COPD急性加重期患者(n= 64)...     

Diagnostic value and influencing factors of fractional exhaled nitric oxide in suspected asthma patients

Objective: To explore the critical value and possible influencing factors of fractional exhaled nitric oxide (FeNO) in suspected asthma patients. Methods: 923 suspected asthmatics consecutively referred to our hospital during December 2012 to July 2014 were selected. All cases were carried out FeNO measurement at first; next, spirometry, bronchoprovocation tests or bronchodilation tests were used to confirm or exclude asthma. Receiver operating characteristic curve (ROC) was used to determine the best cut-off value of FeNO for asthma diagnosis. Results: In bronchoprovocation test, 125 cases were diagnosed as asthma, other 283 were non-asthmatics. FeNO levels of asthmatics were significantly higher than non-asthmatics (median, 64.8 ppb vs. 27.9 ppb, P < 0.01). In this group of patients, 64 ppb was the best cut-off value of FeNO to identify asthma with sensitivity of 52.0% and specificity of 94.35%. In bronchodilation test, 185 patients were diagnosed as asthma, other 330 were non-asthmatics. FeNO levels of asthmatics were significantly higher than non-asthmatics (median, 60.6 ppb vs. 29.05 ppb, P < 0.01). In bronchodilation test patients, 41 ppb was the best cut-off value of FeNO to identify asthma with sensitivity of 72.43% and specificity of 74.85%. Influencing factors analysis showed that sex was an independent factor affecting patients’ FeNO level. Conclusion: FeNO was an effective auxiliary diagnosis method for bronchial asthma. 64 ppb and 41 ppb was the best cut-off value of FeNO to identify asthma in bronchoprovocation test or bronchodilation test, respectively. Sex was an independent factor affecting patients’ FeNO level.     

High fractional concentration of nitric oxide in exhaled air despite steroid treatment in asthmatic children

BACKGROUND: The fractional concentration of nitric oxide in exhaled air (FENO) is elevated in atopic asthma and typically responds to treatment with inhaled corticosteroids (ICS). However, some patients have persistently high FENO levels despite treatment. OBJECTIVE: We studied how optimizing the inhalation technique and increasing ICS doses would affect FENO in stable atopic asthmatic children who had elevated FENO while using ICS. METHODS: In 41 stable asthmatic children who were treated with ICS (median daily dose 800 microg budesonide equivalent, range 100-1600 microg) and maintained FENO> or =20 p.p.b., we optimized the inhalation technique by thorough instruction and measured FENO 2 weeks later. Then, if FENO remained > or =20 p.p.b., we increased the ICS dose and reassessed FENO 2 weeks later. RESULTS: Improving the inhalation technique did not reduce FENO. Increasing ICS from a daily median dose of 800 to 1200 microg budesonide had no significant effect on FENO. FENO correlated positively with symptom scores in the following 2 and 4 weeks (P=0.001, 0.002) and beta2-agonist use the 2 and 4 weeks following FENO measurement (P=0.02, 0.004). CONCLUSION: We conclude that common steps in asthma treatment, i.e. inhalation instruction and increasing ICS dose, were both ineffective in reducing FENO in atopic asthmatic children with elevated FENO values despite treatment with ICS. This implies that FENO cannot simply be incorporated in current treatment guidelines.     

High levels and gender difference of exhaled nitric oxide in Chinese schoolchildren

BACKGROUND: Exhaled nitric oxide (eNO) may represent a useful noninvasive marker of airway inflammation, but data on the reference population values in schoolchildren are limited. No reference eNO study in Asian children has been published. METHODS: Levels of eNO in a sample of 531 schoolchildren aged 11-18 years recruited from five schools (three international schools) in Hong Kong were measured online by a chemiluminescence analyser according to ERS/ATS standard. Each student also completed an International Study of Asthma and Allergic disease in Childhood questionnaire. RESULTS: Among the children without a physician's diagnosis of asthma or symptoms of wheeze, rhinitis and eczema, there were 258 Chinese and 33 Caucasians. In control Chinese children, the eNO level (median: interquantile range) was significantly higher (P<0.001) in males (17.0 parts per billion (p.p.b.); 10.7-36.6) than in females (10.8 p.p.b.; 7.8-17.6). When compared with Caucasian control males (11.6 p.p.b.; 8.2-19.3) and females (9.1 p.p.b.; 7.5-11.9), the Chinese children had significantly higher eNO levels for both males (P=0.011) and females (P=0.037). For Chinese asthmatic males, the median eNO (interquartile range) was 39.8 p.p.b. (12.5-73.8), and for asthmatic females, 18.0 (9.6-56.3). After controlling for sex in Chinese controls, eNO did not have any significant correlation with height, weight and body mass index or body surface area. CONCLUSIONS: This study demonstrates a gender difference of eNO level in healthy Chinese schoolchildren. When compared with Caucasians, Chinese children have significantly higher eNO levels.     

Multiplexed immunoglobulin E sensitization in relation to exhaled nitric oxide in a population sample of children

This study investigated the relationship between the specific immunoglobulin E (IgE) profile for 40 allergens using a novel microarray technique (BioIC) and fraction of exhaled nitric oxide (FeNO) in a population sample of 1321 children. Significant positive associations were found between FeNO and sensitization to mites (P < 0.001), animals (P = 0.001), cockroaches (P < 0.001), and foods (P = 0.042), and furthermore, between FeNO and the number of sensitizations (all P < 0.05) or the sum of specific IgE (all P ≤ 0.01) against the aforementioned allergen categories. Specifically, sensitization to the following allergens was significantly related to higher FeNO: Dermatophagoides pteronyssinus, Dermatophagoides farina, Blomia tropicalis, cat, German cockroach, Oriental cockroach, codfish, crab, shrimp, and cheese (all P ≤ 0.01). In conclusion, IgE sensitization to mites, pets, cockroaches, seafood, and cheese, respectively, is significantly associated with elevated FeNO levels in a dose‐dependent fashion in children. Our results provide new evidence that sensitization to certain food allergens may contribute to prompt inflammation in the airways.     

Determinants of increased exhaled nitric oxide in patients with suspected asthma

Exhaled nitric oxide (FENO) has been proposed as a marker of asthmatic inflammation, but it is unclear whether FENO in clinical use selects patients primarily according to their atopic or asthmatic status. The aim of this study was to investigate the determinants of increased FENO in patients with suspected asthma, by means of multinomial logistic regression analysis. The FENO of 132 patients referred because of symptoms suggestive of asthma were studied, and the explanatory factors tested included atopy according to prick skin tests, clinical asthma according to lung function tests, sputum eosinophilia and bronchial hyperresponsiveness (BHR). Slightly elevated FE(NO) levels were significantly explained only by sputum eosinophilia (OR: 3.7; 95% CI: 1.1-13.1; P=0.04), but for high levels of FE(NO) (> or =3 SD of predicted), clinical asthma (OR: 16.3; 95% CI: 5.4-49.7; P <0.0001) and sputum eosinophilia (OR: 12.0; 95% CI: 4.1-35.0; P >0.0001) were the characteristics with the highest prediction, followed by atopy and BHR. A significant interaction between asthma and atopy was observed relating to the effect on high FENO, but further analyses stratified by atopy showed significant associations between asthma and high FENO both in atopic and nonatopic patients. We conclude that in patients with symptoms suggesting asthma, slightly elevated and high levels of FENO are associated with sputum eosinophilia, whereas asthma is significantly associated only with high levels of FENO, irrespective of atopy. The results suggest that FENO is primarily a marker of airway eosinophilia, and that only high values of FENO may be useful to identify patients with atopic or nonatopic asthma.