呼出气一氧化氮对成人支气管哮喘治疗的指导作用

目的 探讨呼出气一氧化氮测定对成人支气管哮喘治疗的指导作用。方法 选取在北京协和医院门诊就诊的64 例哮喘患者, 所有患者进行哮喘控制测试（ ACT） 调查表的填写及呼出气一氧化氮（ FeNO） 、肺功能测定, 记录FeNO 值及第1 秒用力呼气容积（ FEV1 ） 、第1 秒用力呼气容积占预计值百分比（ FEV1% pred） , 根据FeNO 值分为FeNO 增高组（ n =33） 和FeNO 正常组（ n =31） , 两组患者均给予长效β2 受体激动剂/ 吸入性皮质激素（ ICS/LABA, 沙美特罗替卡松50 /250） 规律治疗,3 个月后随诊, 复测肺功能、FeNO, 填写ACT评分量表。结果 两 组患者治疗后ACT 评分较治疗前均有明显改善, FeNO 增高组ACT 评分高于FeNO 正常组（ 22. 07 ±5. 49 比19. 23 ±5. 48, t = 2. 893,P 〈0. 05） , FeNO 增高组完全控制率高于FeNO 正常组（ 42. 42% 比19. 35% , X2 = 3. 960, P 〈 0. 05） ;FEV1、FEV1% pred 两组较治疗前均有明显改善, FeNO 增高组治疗后FEV1、FEV1% pred 均高于FeNO正常组, 但差异无统计学意义。FeNO、FeNO 改善率与治疗前ACT 评分呈负相关（ r = - 0. 302, P 〈0. 05; r=0. 674, P 〈0. 01） , 与治疗后ACT 改善值呈正相关（ r = 0. 514, P 〈 0. 01; r = 0. 674, P 〈0. 01） 。FeNO 及FeNO 改善率与治疗前后FEV1、FEV1% pred 均无相关性。结论 吸入ICS/LABA 对FeNO增高的支气管哮喘患者疗效较好, FeNO 值越高吸入ICS/LABA 后临床症状改善越明显, FeNO 可用于预测哮喘患者对吸入ICS/LABA 治疗的敏感性, 指导哮喘临床治疗。

The Predictive Value of Fractional Exhaled Nitric Oxide in the Treatment Response of Adult Asthmatic Patients

Objective To explore the predictive value of fractional exhaled nitric oxide （ FeNO） in the treatment response of adult asthmatic patients.
Methods 64 adult outpatients with asthma from Peking Union Hospital between March and September 2013 were recruited in the study. All patients completed asthma control test （ ACT） together with exhaled nitric oxide （ FeNO） and pulmonary function test. Then the patients were classified into a higher FeNO group （ n =33） and a normal FeNO group （ n =31） according to FeNO level. All patients accepted regular inhaled ICS/LABA treatment （ salmeterol and fluticasone 50/250） . Three months later all patients reaccepted ACT, FeNO and pulmonary function test.Results The ACT score increased in all patients, and was significantly higher in the higher FeNO group than that in the normal FeNO group 22. 07 ±5. 49 vs. 19. 23 ±5. 48, t = 2. 893, P 〈 0. 05] . The complete control rate of the higher FeNO group was higher than that in the normal FeNO group （ 42. 42% vs. 19. 35% , X2 =3. 960,P 〈0. 05） . The FEV1 and FEV1%pred of two groups both increased significantly （ P 〈0. 05） , but there was no significant difference between two groups （ P 〉0. 05） . Correlation analysis showed that FeNO and the declined rate of FeNO was negatively correlated with the ACT score（ r = - 0. 302, P 〈 0. 05; r =0. 674, P 〈0. 01） and positively correlated with the improvement of ACT score （ r = 0. 514, P 〈 0. 01; r =0. 674, P 〈0. 01） . No significant correlation was found between FeNO and FEV1 or FEV1% pred.Conclusions The effect of ICS/LABA therapy is better for asthma patients with higher FeNO. FeNO can be used for predicting the response to ICS/LABA therapy in patients with asthma and guiding the treatment.