FeNO 水平对老年哮喘吸入性糖皮质激素治疗的指导意义

【目的】探讨呼出气中 NO 浓度(fraction of NO in exhaled air,FeNO)水平对哮喘吸入性糖皮质激素(inhaled corticosteroids,ICS)治疗的指导意义。【方法】收集 ICS 治疗的老年哮喘患者193例(≥60岁),根据治疗前 FeNO 水平分为三组。A 组：FeNO 正常(<25 ppb)36例；B 组：FeNO 中水平(25~50 ppb)49例；C 组：FeNO 高水平(>50 ppb)108例。检测各组嗜酸性粒细胞计数(Eos%),比较各组治疗前后哮喘控制问卷(Asthma Control Questionnaire,ACQ)评分差值(△ACQ)和第1秒用力呼气量(forced expiiratory vol-ume in one second,FEV1)差值(△FEV1),并分析 FeNO 与各指标的相关性。【结果】①ACQ 改善情况：经治疗后 B、C 组△ACQ 分别为1.83、1.65,明显高于 A 组0.86,差异有统计学意义(P <0.05)；B、C 组中△ACQ>1和1≤△ACQ 且 ACQ≤0.75人数比例均明显高于 A 组,差异有统计学意义(P <0.05))。②肺功能改善情况：各组治疗后 FEV1明显增加(P <0.05),但 A、B、C 组△FEV1比较差异无统计学意义(P >0.05)。相关性分析显示：治疗前 FeNO 水平与△ACQ 和诱导痰 Eos%均呈正相关(P <0.05)；治疗后 FeNO 水平与△ACQ、诱导痰 Eos%无相关性(P >0.05)。【结论】FeNO 是较好的气道过敏性炎症指标,不同 FeNO 水平患者对 ICS 的反应性存在差异。动态监测 FeNO 水平可作为评估哮喘控制情况和指导其治疗的指标之一。

Guiding Significance of FeNO Levels in the Treatment of Inhaled Corticosteroids for Asthma in the Elderly

Objective]To investigate the guiding significance of FeNO (fraction of NO in exhaled air)lev-el in the treatment of inhaled corticosteroids (ICS)in asthma patients.Methods]The 1 93 asthma patients who were newly diagnosed and received ICS treatment were chosen and divided into three groups based on their FeNO levels (36 cases in group A (<25 ppb),49 cases in group B (25~50 ppb),and 108 cases in group C (>50 ppb)).The indicators,including improvement of ACQ scores and lung function,were compared among three groups.The correlation between FeNO levels and indictors were analyzed.Results]① The improve-ment of ACQ scores (Asthma Control Questionnaire):The average △ACQ of group B and C were 1.83 and 1.65 respectively,which were significantly higher than that of group A (0.86),(P <0.05).The percentage with △ACQ?1 in group B and C were higher than that in group A (P <0.05).② The improvement of lung function:The FEV1 (forced expiratory volume in one second)increased after treatment(P <0.05 ),but the differences among three groups were of no significance (P >0.05).Correlation analysis showed that the Fe-NO levels was significantly positively correlated with △ACQ and Eos% in induced sputum (P <0.05)before treatment,While after treatment there were no significant correlations between FeNO levels and △ACQ or Eos% in induced sputum.Conclusion]FeNO is a relatively better indicator of allergic inflammation of airway. The reactions to ICS treatment are different among asthma patients with different FeNO levels.