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CaNO、FeNO联合肺功能在支气管哮喘诊断中的应用价值

Application value of CaNO and FeNO combined with lung function in diagnosis of bronchial asthma

    摘要
  • 摘要:
      背景  肺泡一氧化氮(concentration of alveolar nitric oxide，CaNO)和呼出气一氧化氮(fractional exhaled nitro oxide，FeNO)分别是哮喘肺泡腺泡区小气道炎症和气管支气管为主大气道炎症的无创评价指标，英国国家卫生与临床优化研究所(NICE)指南推荐FeNO结合其他哮喘辅助检查可以作为哮喘诊断的参考指标，CaNO作为小气道的炎症标志物，在哮喘诊治方面研究不多。大小气道联合评估可全面反映气道炎症水平，可克服单一检查方法的不足。
      目的  探讨CaNO和FeNO联合肺功能参数在哮喘诊断的应用价值。
      方法  回顾分析2019年3 - 9月就诊于解放军总医院第一医学中心呼吸科门诊的哮喘患者(66例)为哮喘组，选取同时期有咳嗽气短症状的非哮喘者(37例)为对照组。对比两组一般资料、CaNO、FeNO、肺功能参数，ROC曲线检测CaNO、FeNO单独及联合肺功能参数诊断哮喘的价值。
      结果  两组一般资料差异无统计学意义(P＞0.05)。CaNO、FeNO哮喘组高于对照组，肺功能参数FEV1%、FVC%、FEV1/FVC%、MMEF%、FEF75%、FEF50%低于对照组(P＜0.05)。CaNO诊断哮喘临界值3.45×109 mol/L，此时的敏感度为72.7%，特异性为86.5%，ROC曲线下面积为0.872 (95% CI：0.804 ~ 0.941)。FeNO诊断哮喘的临界值为30.5×109 mol/L，此时的敏感度为62.1%，特异性为83.8%，ROC曲线下面积0.770 (95% CI：0.679 ~ 0.860)。CaNO和FeNO联合肺功能参数FEV1%、FVC%、MMEF%、FEF50%诊断哮喘价值均高于单独CaNO、FeNO检测。并且CaNO + FeNO + FEV1检测曲线下面积最大，为0.954 (95% CI：0.915 ~ 0.993)，敏感度为93.9%，特异性为86.5%。CaNO + FeNO + FEF50检测阳性似然比最高，为31.407，阴性似然比0.156，曲线下面积0.952 (95% CI：0.912 ~ 0.992)。
      结论  CaNO、FeNO联合肺功能参数可作为哮喘诊断的补充工具。

     

    Abstract:
      Background   Concentration of alveolar nitric oxide (CaNO) and fractional exhaled nitro oxide (FeNO) are noninvasive indicators of small airway inflammation in alveolar acinar area and primary airway inflammation in large airway in asthma, respectively. The Guidelines of the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom recommend FeNO combined with other asthma adjuvant tests as a reference indicator for the diagnosis of asthma. As an inflammatory marker of small airways, CaNO has not been studied in the diagnosis and treatment of asthma. The combined assessment of small and large airway inflammation can comprehensively reflect the level of airway inflammation, which can overcome the shortcomings of a single test.
      Objective   To investigate the value of CaNO and FeNO combined with lung function parameters in the diagnosis of asthma.
      Methods   A retrospective analysis was conducted on 66 asthma patients treated in the Department of Respiratory of the First Medical Center, Chinese PLA General Hospital from March to September in 2019, and the patients were included as asthma group, another 37 non-asthmatic patients with cough and shortness of breath during the same period as control group. The general data, CaNO, FeNO, pulmonary function parameters were compared between the two groups, and ROC curve was used to detect the value of CaNO or FeNO alone and combined lung function in the diagnosis of asthma.
      Results   There was no statistical difference in general data between the two groups (P>0.05). CaNO level and FeNO level in the asthma group were higher than those in the control group, and the levels of lung function parameters FEV1%, FVC%, FEV1/FVC%, MMEF%, FEF75% and FEF50% were lower than those in the control group (P<0.05). The critical value for CaNO diagnosis of asthma was 3.45 × 109 mol/L, at which the sensitivity, specificity and area under ROC curve were 72.7%, 86.5% and 0.872 (95% CI 0.804-0.941), respectively. The critical value of FeNO for the diagnosis of asthma was 30.5 × 109 mol/L, with sensitivity of 62.1%, specificity of 83.8%, area under ROC curve of 0.770 (95% CI 0.679-0.860). The diagnostic value of CaNO and FeNO combined with FEV1%, FVC%, MMEF% and FEF50% was higher than that of CaNO or FeNO alone, and the area under the curve of CaNO + FeNO + FEV1 was the largest, which was 0.954 (95% CI 0.915-0.993), with sensitivity of 93.9%, specificity of 86.5%, and the positive likelihood ratio of CaNO + FeNO + FEF50 was the highest (31.407), the negative likelihood ratio was 0.156, and the area under the curve was 0.952 (95% CI 0.912-0.992).
      Conclusion   CaNO and FeNO combined with lung function test can be used as a supplementary tool for asthma diagnosis.

     

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