哮喘患者呼出气一氧化氮及血嗜酸性粒细胞水平相关性研究

目的探讨哮喘患者呼出气一氧化氮和血嗜酸性粒细胞百分比水平之间的相关性。方法随机选择160例急性期哮喘患者及正常对照人群160例检测呼出气一氧化氮及血中嗜酸性粒细胞含量百分比,研究两者相关性。结果急性期哮喘患者呼出气一氧化氮和血中嗜酸性粒细胞百分比之间具有正相关。结论哮喘患者同时检测呼出气一氧化氮和血嗜酸性粒细胞百分比可以提高诊断准确率,而且可以作为哮喘治疗及病情监测指标之一。     

呼出气一氧化氮与支气管哮喘

<正>近年来,随着我国大气污染的加重,支气管哮喘(简称哮喘)的发病率逐年上升。哮喘目前还不能完全根治,反复发作为其特点,故及早诊断和规范化治疗至关重要。气道慢性炎症是哮喘的本质,其主要病理生理特征是气道高反应性[1]。因此,准确地判断气道炎症程度,有助于提高患者的治疗依从性。呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)是反映气道炎症的指标之一,可与支气管激发     

嗜酸性粒细胞与非嗜酸性粒细胞哮喘

<正>哮喘是一种由嗜酸性粒细胞(eosinophils,Eos)、肥大细胞、T淋巴细胞等多种细胞和细胞组分参与的气道慢性炎症疾病,其发病机制极为复杂,迄今尚未阐明。以往对哮喘中炎症细胞的研究多着重于Eos、肥大细胞等,学者多以Thl/Th2失衡来解释。随着对哮喘发生机制研究的不断深入以及临床上激素抵抗型哮喘的出现,近年提出了非嗜酸性粒细胞型哮喘(non-eosinophils asthma,NEA)的概念,在发生机制和临床特征上与传统的嗜酸性粒细胞哮喘(eosinophils asthma,EA)有着较大的区别,对治疗疗效也有一定的影响。     

嗜酸性粒细胞与支气管哮喘

在１９９５年世界卫生组织（ＷＨＯ）和美国国立心肺血液研究所发表的“全球哮喘防治的创议”中将哮喘定义为一种“气道的慢性炎症性疾病”，并指出这种气道炎症是由嗜酸性粒细胞（ＥＯＳ）等炎性细胞参与形成的非特异性炎症。人们很早就发现哮喘患者体内有明显的ＥＯＳ增...     

嗜酸性粒细胞与支气管哮喘

1879年Ehrlich发现了嗜酸性粒细胞(EC)。但此后100年间人们对EC在哮喘中的作用一直不甚了解。直到本世纪初,人们发现哮喘患者的周围血和肺组织中EC数量明显增加。1975年Horn等发现多数哮喘患者的发作程度与其血、痰中的EC升高呈正相关,其气道反应性也是如此。后来又有人发现,哮喘患者吸入过敏原时,其支气管肺泡灌洗液(BALF)和肺组织中的EC数量显著增加。于是,人们才开始注意EC与气道反应性及哮喘发作的关系。此后,许多学者就此做了大量的深入研究。目前认为,哮喘是以气道肥大细胞(MC)和EC浸润为主的慢性炎性疾病。     

过敏性支气管哮喘气道炎症与嗜酸性粒细胞产生的关系

过敏性支气管哮喘（以下简称哮喘）是气道的一种慢性炎症性疾病，炎性细胞尤其是嗜酸性粒细胞（Eos）是哮喘气道炎症反应的主要效应细胞。激活的Eos通过释放主碱性蛋白、阳离子蛋白、白三烯（LTs）等有害物质在哮喘的组织损伤及临床症状的发生中发挥关键作用。Eos是由造血干细胞分化而来。传统的观点认为，个体发育成熟后造血干细胞的分化与成熟仅局限于骨髓。但近年的研究发现，造血干细胞在特定细胞因子和趋化因子协同作用下也可由骨髓释放出来，定位到各种组织与器官，然后在局部生长因子的调控下，再分化与成熟为特定的成熟细胞，即所谓“原位造血”。现就过敏性哮喘气道炎症与骨髓造血及原位造血Eos产生的关系作一介绍。     

动态监测哮喘患者诱导痰嗜酸性粒细胞的临床意义

目的　探讨利用诱导痰中嗜酸性粒细胞 (EOS)评价哮喘患者气道炎症变化的方法 ,为如何相对准确监测哮喘患者气道炎症的改变提供临床实验资料。方法　分别对 2 8例哮喘患者(哮喘组 ,其中轻度组 15例、中度组 13例 )、16例回访者 (哮喘回访组 )和 14例健康自愿者 (对照组 )进行痰的诱导 ,所有检查者通过超声雾化吸入浓度为 4%～ 5 %的高渗盐水 3 0min ,选取诱导出的痰栓 ,用 0 .1%的二硫苏糖醇处理 ,单盲法计数EOS。结果　哮喘组诱导痰EOS数占炎性细胞百分比高于对照组 ,哮喘轻度组与中度组EOS数占炎性细胞百分比比较差异无显著性 (P >0 .0 5 ) ,哮喘回访组缓解前后EOS比较差异有非常显著性 (P <0 .0 1)。结论　单纯一次EOS计数值不能说明患者病情的轻重 ,但对同一患者动态监测其发病过程中诱导痰EOS的变化可以在一定程度上反映其病情改变     

呼出气一氧化氮检测对支气管哮喘患者激素治疗敏感性的预测价值

目的探讨呼出气一氧化氮（FeNO）检测对支气管哮喘（简称哮喘）激素治疗敏感性的预测价值。方法纳入我院门诊2012年4月至2013年3月的116例新发哮喘患者,行FENO检测、哮喘控制情况问卷（ACT）;根据FeNO水平进行分组,FeNO≥50ppb为高水平组（46例）、FeNO值在25～50ppb为中水平组（44例）、FeNO≤25ppb为低水平组（26例）,所有患者正规吸入糖皮质激素联合长效Bz受体激动剂,12周后复查FeNO及ACT评分。结果治疗前哮喘患者FeNO与ACT评分呈负相关（R=-0．455,P〈0．0001）,治疗后不相关（R=-0．171,P=0．066）;各水平组治疗前、后FENO变化进行比较,高、中水平组FeNO显著下降（t=16．83,t=14．53,P〈O．0001）,低水平组较治疗前下降不明显（t=2．030,P=0．054）;根据治疗后ACT评分判断病情是否控制,高水平组控制率（81．40A）与中水平组控制率（72．5％）比较差异无统计学意义（x2=-0．93,P〉0．05）,中水平组控制率与低水平组控制率（44．0％）差异有统计学意义（X2=5．28,P〈O．05）。结论FeNO具有识别嗜酸粒细胞炎症型哮喘及预测糖皮质激素治疗疗效的价值。     

学龄期儿童哮喘检测呼出气一氧化氮、肺功能及外周血嗜酸性粒细胞的价值

目的 检测学龄期儿童哮喘呼出气一氧化氮(FeNO)水平、肺功能及外周血嗜酸性粒细胞计数(EOS)水平,分析其临床应用价值.方法 选择学龄期哮喘儿童共90例,分为急性发作组、慢性持续组和缓解组,以同时期同年龄门诊健康查体的正常儿童30例为对照组,各组均进行FeNO、肺功能、血EOS检测并比较,并采用Spearman相关分...     

支气管哮喘患儿呼出气一氧化氮及血清嗜酸粒细胞阳离子蛋白的变化

目的探讨呼出气一氧化氮(eNO)在支气管哮喘(AS)儿童中的应用,比较eNO和血清嗜酸粒细胞阳离子蛋白(ECP)在AS、AS合并过敏性鼻炎(AR)、慢性咳嗽变异性哮喘(CVA)的不同,寻找适用于儿童AS简便易行的气道炎症监测指标方法.方法 设定50 ml/s呼出气流速,采用电化学法对51例5～14岁患有AS、AS/AR、CVA的患儿,及30例5～14岁正常对照组儿童进行eNO测定,同时测定ECP及第1秒用力呼气容积占预计值百分比(FEV1pred%).结果 AS、AS/AR、CVA三组间eNO、ECP水平均高于对照组(P＜0.01);AS/AR组eNO、ECP水平均高于AS、CVA组(P值均＜0.05),而AS、CVA组间则无明显差异(P＞0.05);AS组eNO与ECP间存在显著相关性(r＝0.64,P＜0.05),但与FEV1间则无明显相关性(r＝0.144,P＞0.05).结论 eNO水平在AS/AR组增高,提示eNO在过敏性体质中高表达.eNO浓度与血清ECP呈正相关,提示eNO可以反映AS患者气道嗜酸性炎症水平.     

临床控制的哮喘患者小气道功能和呼出气 NO 水平测定的临床意义简

目的 检测临床控制的哮喘患者小气道功能和呼出气一氧化氮（NO）的水平,探讨其临床意义.方法 对38例临床控制的哮喘患者做肺功能及呼出气NO浓度测定.选择22例初诊哮喘患者和20例健康者作为对照组.结果 38例临床控制哮喘患者中,小气道功能异常22例（57.9%）,正常16例（42.1%）,呼出气NO浓度为（30.42±25.35） ppb,显著低于初诊哮喘组[（80.28±45.62） ppb,P〈0.01],但显著高于健康对照组[（16.15±11.23） ppb,P〈0.01].小气道功能异常哮喘患者呼出气NO浓度为（42.29±23.12） ppb,显著高于小气道功能正常患者呼出气NO浓度[（20.54±10.12） ppb,P〈0.01].结论临床控制的哮喘患者小气道功能异常可能与气道炎症持续存在有关,测定患者小气道功能和呼出气NO浓度有助于指导哮喘治疗.     

Measurement of exhaled nitric oxide: comparison of different analysers

Background and objective: Exhaled nitric oxide (NO) is used as a surrogate marker to monitor eosinophilic airway inflammation, assist in diagnosis, and support treatment decisions for asthma patients. The aim of this study was to compare five NO analysers: Medisoft (M), Aerocrine Niox (N), Aerocrine Niox flex (NF), Aerocrino Niox mino (NM) and EcoMedics (E). Methods: In 85 subjects (25 asthma patients, 25 COPD patients, 35 healthy volunteers; median age 36.5 years, range 23–79, 47% female), three NO measurements per individual were performed, using each analyser according to the American Thoracic Society/European Respiratory Society guidelines. Subjects evaluated the devices on the basis of comfort and ease of performing the measurement. Results: Median NO concentrations were 24.8 parts per billion (ppb) (range 6.3–262.7) for M, 14.5 ppb (0.0–196.6) for N, 15.2 ppb (5.6–67.7) for NF, 16.3 ppb (5.0–208.3) for NM, and 13.1 ppb (4.0–103.0) for E. There was significant correlation among the absolute NO values measured with all the devices (0.743 for M vs NF < r < 0.979 for N vs NF). Bland–Altman plots suggested an acceptable degree of agreement among the results obtained with the three Niox analysers. Measurements obtained with the Medisoft and Ecomedics analysers were not directly comparable with those obtained with the other devices. The greatest differences in absolute NO levels for individual patients were between measurements with the M and E analysers (8.3 ppb, range 27.4–159.7, P < 0.001). Acceptance of the measurements by patients was high, independent of the device used. Conclusions: Exhaled NO values obtained with different devices were not directly comparable and may differ to a clinically relevant extent, depending on which device is used.     

呼出气一氧化氮在哮喘诊断中的价值及与肺功能相关性

目的 阐明呼出气一氧化氮（eNO）在不同呼吸系疾病的诊断价值及哮喘患者中eNO与不同肺功能结果的相关性.方法 呼吸系疾病患者共398人,同时检测eNO值、FEV1%预计值、支气管舒张试验.结果 哮喘eNO值明显高于其他呼吸系疾病eNO值.哮喘患者中支气管舒张试验阳性组eNO≥50 ppb占53.8%;支气管舒张试验阴性组eNO＜50 ppb占63.4%.按肺功能严重度分组,各组间eNO值无明显差异.结论 eNO是诊断哮喘可靠的标志物之一;哮喘患者中eNO值与支气管舒张试验结果存在一定相关性,与肺功能严重度无明显关联.     

老年支气管哮喘患者FeNO与肺功能的相关性

目的探讨老年支气管哮喘患者呼出气一氧化氮(Fe NO)水平与肺功能的相关性。方法对68例老年哮喘患者给予吸入舒利迭和异丙托溴铵喷雾剂,疗程为1个月。比较50例健康体检者及哮喘患者治疗前、治疗后Fe NO、肺功能变化,采用哮喘控制测试(ACT)评分评价其疗效。结果与对照组比较,哮喘组治疗前Fe NO、Eos、N水平明显升高,各肺功能指标明显下降(P0.05);治疗后,各指标均明显改善(P0.05),PEF、FEV1、Eos、N基本恢复至对照组水平(P0.05);治疗后完全控制组、部分控制组各项指标均优于未控制组,完全控制组Fe NO、Eos、N水平均明显低于部分控制组(P0.05);治疗前,哮喘组患者Fe NO水平与Eos、N呈正相关(P0.05),与肺功能指标呈负相关(P0.05),但治疗后,Fe NO水平与Eos、N呈正相关(P0.05)。结论 Fe NO水平在哮喘患者中明显升高,结合肺功能检查,有助于提高老年哮喘的诊断及治疗水平。     

Environmental exposures,nitric oxide synthase genes,and exhaled nitric oxide in asthmatic children

Exhaled nitric oxide (FeNO), a measure of airway inflammation, is being explored as a tool to guide asthma management in children. Investigators have identified associations of genetic polymorphisms in nitric oxide synthase genes (NOS1 and NOS3) with FeNO levels; however, none have explored whether these polymorphisms modify the relationship of environmental exposures with FeNO. The objective of this project was to evaluate the association of NOS polymorphisms and environmental exposures with FeNO levels among children with asthma. We conducted a 12‐month prospective cohort study of 225 tobacco‐smoke exposed children (6–12 years) with doctor‐diagnosed asthma. We assessed environmental exposures (tobacco, indoor allergens, & airborne particulates), polymorphisms in NOS1 (an intronic AAT tandem repeat) and NOS3 (G894T), and FeNO levels. There was no association of NOS1 or NOS3 polymorphisms with FeNO levels. There were no significant interactions of environmental exposures and the NOS1 polymorphism with FeNO levels. In contrast, there was an interaction of the NOS3 polymorphism and airborne nicotine concentration with FeNO levels (P = 0.01). Among GG genotype individuals, nicotine exposure did not affect FeNO levels; however, among individuals with at least one T allele, higher nicotine exposure was associated with lower FeNO levels (approximately 5 ppb decrease from the lowest to the highest quartile). We conclude that genetic differences may explain some of the conflicting results in studies of the effects of tobacco smoke exposure on FeNO levels and may make FeNO interpretation difficult for a subset of children with asthma. Pediatr Pulmonol. 2009; 44:812–819. © 2009 Wiley‐Liss, Inc.     

A comparative study of the RuiBreath and NIOX VERO analyzers for detecting fractional exhaled nitric oxide

BackgroundFractional exhaled nitric oxide (FeNO) measurement is a reliable, noninvasive marker of airway inflammation. Portable FeNO analyzers facilitate the assessment of airway inflammation in primary care. Differences between analyzers from different manufacturers are not comparable. Here, we aimed to compare the FeNO values obtained by a new portable device (RuiBreath, Guangzhou Ruipu Medical Technology Co., Ltd, Guangzhou, China) to those obtained by the widely used NIOX VERO portable analyzer (Aerocrine AB, Solna, Sweden) in patients with asthma.MethodsThis prospective validation study enrolled patients (≥14 years old) with asthma over a 2-month period (July and August 2019) at the Beijing Chao-Yang Hospital. At least one valid FeNO measurement was obtained using each analyzer for all the participants.ResultsThere were 197 participants in this study. The FeNONIOX and FeNORuiBreath values significantly differed (P=0.016). After log-transformation, a difference was found only when the FeNONIOX was <25 ppb (P<0.001). The FeNONIOX and FeNORuiBreath values had a significant correlation (r=0.938, P<0.001), which was confirmed by the Altman-Bland plot. Using a receiver-operating characteristic curve analysis, when using 49 ppb as the cut-off point for the two devices in identifying patients with symptomatic asthma symptoms, the sensitivity and specificity were 0.42 and 0.88, respectively, by NIOX, and 0.40 and 0.89, respectively, by RuiBreath.ConclusionsThis is the first report of FeNO values obtained by the new portable RuiBreath FeNO analyzer. The FeNORuiBreath values are reliable and directly comparable with the FeNONIOX values.     

Time spent in vigorous physical activity is associated with increased exhaled nitric oxide in non‐asthmatic adolescents

Introduction: Physical activity (PA) is important in preventing disease, but endurance elite athletes have increased prevalence of asthma and airway inflammation. Objectives: We aimed to determine if PA was associated with increased fractional exhaled nitric oxide (FE_NO) in asthmatic and non‐asthmatic adolescents. Methods: FE_NO was recorded (Niox Mino®, Aerocrine AB, Stockholm, Sweden) in 169 adolescents (13–14 years) in a nested case–control analysis from the Environment and Childhood Asthma study, Oslo, 92 adolescents with and 77 without asthma. They underwent clinical examination, lung function measurements and treadmill run measuring peak oxygen uptake, and objectively recorded PA for four consecutive days. PA was classified as moderate, vigorous and very vigorous, and total number of hours of each category was recorded for each subject. Associations between FE_NO and PA were tested using linear robust multiple regression analyses. Results: In non‐asthmatic adolescents, FE_NO was associated with daily hours of vigorous to very vigorous (r = 0.27, P = 0.02) and very vigorous PAs (r = 0.25, P = 0.036) in bivariate analyses. In multivariate analyses, FE_NO was associated with vigorous to very vigorous PA [regression coefficients (95% confidence interval) 1.9 (0.6, 3.1); P = 0.004] and more strongly with very vigorous PA [3.9 (1.5, 6.4); P = 0.002] in non‐asthmatic but not in asthmatic adolescents. Total daily PA was not associated with FE_NO in either group. Thus, 1 h of very vigorous PA per day increased FE_NO by 3.9 ppb. Conclusion: Vigorous to very vigorous PA, contrasting total daily PA, was significantly associated with increased FE_NO in non‐asthmatic adolescents, suggesting that intensive PA may induce airway inflammation independent of asthma. Please cite this paper as: Sachs‐Olsen C, Berntsen S, Lødrup Carlsen K, Anderssen SA, Mowinckel P and Carlsen K‐H. Time spent in vigorous physical activity is associated with increased exhaled nitric oxide in non‐asthmatic adolescents. Clin Respir J 2013; 7: 64–73.     

Decreased concentration of exhaled nitric oxide (NO) in patients with cystic fibrosis

Nitric oxide (NO) is produced by various cell types in the human respiratory tract. Endogenously produced nitric oxide is detectable in the exhaled air of healthy individuals. Exhaled NO has been shown to be increased in airway inflammation, most probably due to cytokine-mediated activation of NO synthases. To assess whether NO can serve as a marker of inflammation in cystic fibrosis (CF) lung disease, we measured exhaled NO in CF patients with a chemiluminescence analyser. Single breath measurements were performed in 27 stable CF patients (age range, 6–40 years) and 30 non-smoking controls (age range, 6–37 years). Exhaled NO concentrations were 9.1 ± 3.6 ppb in the controls and 5.9 ± 2.6 ppb (P < 0.001) in CF patients. To account for room air NO concentrations on the measurement of exhaled NO, we also calculated the difference between exhaled NO and ambient NO concentrations. Difference values were also significantly lower in CF compared with controls (P < 0.0001). In CF patients there was a positive correlation between exhaled NO and forced vital capacity (r = 0.43, P = 0.033), suggesting that exhaled NO is lower in patients with severe lung disease than in those with mild disease. We conclude that measurements of exhaled NO in CF does not reflect activity of CF airway inflammation. The decreased concentrations of exhaled NO may be due to inhibitory effects of inflammatory cytokines on NO synthases in the airways and alveolar epithelial cells or to increased retention in airway secretions. Pediatr. Pulmonol. 1997; 24:173–177. © 1997 Wiley-Liss, Inc.