初诊哮喘患者的呼出气一氧化氮与大小气道功能的 相关性及临床价值分析

目的 探讨初诊支气管哮喘患者的呼出气一氧化氮水平与大小气道功能的相关性，以及在哮喘规范化治疗中的变化趋势及临床意义。方法 选择2016年3月~2016年5月就诊于新乡医学院第一附属医院呼吸科的初诊成人支气管哮喘患者80例，为哮喘组；选择同期健康体检志愿者40名，为对照组。哮喘组在治疗前及治疗后3、6、9、12月分别行FeNO和肺功能检查包括FEV1%、FEF75%、FEF50%、MMEF%以及哮喘控制测试（ACT）；健康志愿者仅行一次肺功能及FeNO检查。结果 初诊哮喘的FeNO与FEV1%无相关性（P＞0.05），与FEF75%、FEF50%、MMEF%存在负相关（P＜0.05）。经治疗大气道功能的恢复时间6个月早于小气道功能的恢复时间12个月，FeNO的恢复时间约3月。小气道功能异常的哮喘患者比小气道功能正常者具有更高的FeNO，且在1年的治疗过程中具有更高的急性发作次数和吸入糖皮质激素（ICS）用量，差异有统计学意义（P＜0.05）。结论 相比于大气道，小气道功能异常与气道炎症FeNO的关系更密切。大气道功能不能完全反映哮喘的临床控制情况，需联合检测FeNO与小气道功能。

Correlation and Clinical Value Analysis of Exhaled Nitric Oxide and Airway Function in Patients with Newly Diagnosed Asthma

Abstract:Objective To investigate the correlation between exhaled nitric oxide level and airway function in patients with newly diagnosed bronchial asthma,and to explore the trend and clinical significance of the level of exhaled nitric oxide in the standardized treatment of asthma.Methods From March 2016 to May 2016,80 patients with newly diagnosed adult bronchial asthma in the Department of Respiratory Medicine of the First Affiliated Hospital of Xinxiang Medical College were selected as the asthma group, and 40 healthy volunteers during the same period were selected as the control group.The asthma group before and after treatment in 3,6,9 and 12 months respectively for FeNO and pulmonary function tests including FEV1%,FEF75%,FEF50%,MMEF% and asthma control test(ACT);healthy volunteers only a pulmonary function and FeNO.Results There was no correlation between FeNO and FEV1% in primary asthma(P>0.05),and had negative correlation with FEF75%,FEF50% and MMEF%(P<0.05).The recovery time of the function of the large airway was 6 months earlier than the recovery time of the small airway function for 12 months,and the recovery time of FeNO was about 3 months.Patients with small airway dysfunction had higher FeNO than those with normal small airway function,and had higher acute attack times and inhaled corticosteroid(ICS)dosage in 1 years of treatment,the difference was statistically significant(P<0.05).Conclusion Compared with the large airway,the relationship between the abnormal function of small airway and airway inflammation FeNO is more closely related.The function of the large airway can not fully reflect the clinical control of asthma.The function of FeNO and small airway should be detected jointly.