呼出气一氧化氮与慢性咳嗽吸入糖皮质激素治疗疗效的关系

【摘要】 目的：探讨呼出气一氧化氮在慢性咳嗽吸入糖皮质激素治疗疗效中的作用。方法：采用回顾性的方法观察2010年1月一2010年12月在我科就诊的慢性咳嗽患者，进行呼出气一氧化氮（FENO）检测以及沙丁胺醇舒张试验，收集相关临床资料，没有临床资料通过电话回访和问卷调查。结果：①共计62名慢性咳嗽患者进入研究，吸入糖皮质激素（ICS）治疗应答和无应答的患者在年龄、性别、体重指数、FEV1%预测值等方面差异无统计学意义；②ICS治疗应答组患者FENO的水平为48.13±15.66ppb，明显高于ICS治疗无应答组患者的24.90±9.26ppb，差异有统计学意义（P<0.05）；③22名呼出气NO正常慢性咳嗽患者，给予ICS治疗，仅有2名患者治疗有效；④判断ICS治疗有无应答的FENO的临界值为34ppb。结论：FENO水平对慢性咳嗽进行ICS治疗有预测作用，高的FENO水平提示慢性咳嗽对ICS治疗有应答，而低FENO提示ICS治疗效果差，这将有助于慢性咳嗽患者的评价和治疗。

Use of Exhaled Nitric Oxide and the association with the Response to Inhaled Corticosteroids for Chronic Cough

OBJECTIVE: To evaluate our experience with patients who presented with chronic cough and how exhaled nitric oxide predicted response to inhaled corticosteroid (ICS) therapy. METHODS: This retrospective observational study of 114 patients evaluated for chronic cough with measured exhaled nitric oxide and bronchodilatation test was conducted from Jan 1, 2010, through FENO Dec 31, 2010. Clinical records were extracted. Patients with FENO documented follow-up were contacted by telephone and administered a questionnaire. RESULTS: In 62 patients, ICS therapy was started or the current ICS dose increased. There were no difference in age, gender, body mass index (BMI), and FEV1%predicted, et al. Forty patients had elevated exhaled nitric oxide levels (48.13±15.66ppb), which were significantly higher than those of the others. Twenty-two patients with exhaled nitric oxide levels in the reference range were also prescribed ICS, and only 2 had cough improvement. Patients had documented followup that ranged from 4 weeks to 16 months. A cutoff of 34 ppb was found to best differentiate ICS responders and FENO responders. CONCLUSION: Measurement of exhaled nitric oxide accurately predicted response to ICS therapy for chronic cough. Patients with a positive exhaled nitric oxide test result had a strong likelihood of response to ICS, whereas a negative exhaled nitric oxide test result indicated an unlikely response to ICS. This finding may potentially have an impact on how patients with chronic cough are evaluated and treated.