呼出气一氧化氮检测在支气管炎症性肺疾病中的临床应用

目的：探讨呼出气一氧化氮水平(fractional exhaled nitric oxide，FeNO)在支气管哮喘、慢性阻塞性疾病
(chronic obstructive pulmonary diseases，COPD)中的变化情况及与肺功能中第1秒用力呼气量(forced expiratory volume in
the first second，FEV1)、第1秒用力呼气量占用力肺活量的百分比(forced expiratory volume in the first second / forced vital
capacity，FEV1/FVC)的相关性。方法：选取57例疑似支气管哮喘患者(21例为急性发作期、12例为非急性发作期、
24例为非支气管哮喘)、38例COPD患者(25例为急性加重期、13例为稳定期)、26例正常对照者，分别测定FeNO，
FEV1，FEV1/FVC，并进行统计学分析。结果：在FeNO诊断支气管哮喘中，若FeNO以20.15 PPb为切点，57例疑似
支气管哮喘患者诊断为支气管哮喘的阳性预测值94.1%，阴性预测值95.7%，灵敏度97.0%，特异度91.7%；33例确诊为
支气管哮喘患者的FeNO与26例正常对照者比较，差异有统计学意义(P<0.05)；支气管哮喘非急性发作期患者FeNO较
急性期显著下降，差异有统计学意义(P<0.05)，FEV1和FEV1/FVC差异无统计学意义(P>0.05)；支气管哮喘患者FeNO
水平与FEV1和FEV1/FVC无明显相关性(r=-0.186，-0.236，均P>0.05)；38例COPD患者的FeNO，FEV1，FEV1/FVC与
26例正常对照者比较，差异有统计学意义(均P<0.05)；25例COPD急性加重期患者FeNO，FEV1，FEV1/FVC与13例
COPD稳定期比较，差异有统计学意义(均P<0.05)；13例COPD稳定期患者FeNO与正常对照者比较，差异无统计学意
义(P>0.05)；COPD患者FeNO水平与FEV1和FEV1/FVC无明显相关性(r=-0.167，-0.285，均P>0.05)。结论：支气管哮
喘患者FeNO水平显著升高，在用FeNO诊断支气管哮喘中，若FeNO以20.15 PPb为切点，则FeNO诊断该疾病有较高的
灵敏度和特异性；急性发作期FeNO较非急性发作期明显升高，可用于评估支气管哮喘的控制程度。COPD患者FeNO
在急性加重期升高，稳定期无明显升高。

Fractional exhaled nitric oxide in bronchial inflammatory lung diseases

Objective: To explore the change of fractional exhaled nitric oxide (FeNO) and its correlation
with forced expiratory volume in the first second (FEV1), the first second forced expiratory volume
percentage of forced vital capacity (FEV1/FVC) in bronchial asthma and chronic obstructive
pulmonary disease (COPD). Methods: FeNO, FEV1 and FEV1/FVC were measured in 57 suspected asthmatics (21 acute
onsets, 12 non-acute and 24 non-asthma), 38 COPD patients (25 acute exacerbations and 13 stable
stages) and 26 healthy subjects.
Results: In the 57 suspected asthmatic patients, when the optimal cut off value of FeNO was 20.15
PPb, which was used to diagnose asthma and differentiate asthma and non-asthma, the positive
predictive value, the negative predictive value, the sensitivity and the specificity was 94.1%, 95.7%,
97.0%, and 91.7% respectively. There was significant difference in the FeNO level between the 33
asthmatics and 26 healthy subjects (P<0.05). There was also significant difference in the FeNO
level between the acute onset and the non-acute (P<0.05), but not in the FEV1 and FEV1/FVC
level (both P>0.05). There was no significant correlation between FeNO and FEV1, FEV1/FVC in
patients with asthma (r=-0.186, -0.236, both P>0.05). There was significant difference in the levels
of FeNO, FEV1 and FEV1/FVC between the 38 COPD patients and the 26 healthy subjects (all
P<0.05), and also between the 25 acute exacerbations and 13 stable COPDs (all P<0.05), but not
between the 13 stable COPDs and 26 healthy subjects (all P>0.05). FeNO was not correlated with
FEV1 and FEV1/FVC level in COPD patients (r=-0.167, -0.285, both P>0.05).
Conclusion: FeNO level is increased obviously in patients with asthma. The optimal cut off value
of FeNO at 20.15 PPb can differentiate asthma and non-asthma with high sensitivity and specificity.
FeNO is higher for the acute onset than non-acute, which may be useful to evaluate the control
degree. FeNO level is increased in COPD patients in the acute exacerbations, but there is no change
in stable COPD patients compared with the healthy subjects.