作者：艾克东，武志锋，尚苗苗，陈霞

单位：

1.716000陕西省延安市人民医院呼吸与危重症医学科　2.716099陕西省延安市中医医院重症医学科

Units：

1.Department of Respiratory and Critical Care Medicine, Yan'an People's Hospital, Yan'an 716000, China2.Intensive Care Unit, Yan'an Hospital of Traditional Chinese Medicine, Yan'an 716099, ChinaCorresponding author: WU Zhifeng, E-mail: 691088545@qq.com

关键词：

哮喘；支气管舒张试验；支气管激发试验；呼出气一氧化氮；气道反应性

Keywords：

Asthma; Bronchial dilation test; Bronchial provocation test; Exhaled nitric oxide; Airway responsiveness

CLC：

R 562.25

DOI：

10.12114/j.issn.1008-5971.2023.00.250

Funds：

陕西省教育厅专项科研计划项目（16JK2031）

摘要：

目的　分析支气管舒张试验阴性的哮喘患者呼出气一氧化氮（FeNO）与气道反应性的关系。方法选取2019年3月至2022年3月延安市人民医院和延安市中医医院收治的150例支气管舒张试验阴性的疑似哮喘患者。收集患者的一般资料，测定患者FeNO及肺功能指标〔包括第1秒用力呼气容积（FEV1）占预计值百分比、用力肺活量（FVC）占预计值百分比、FEV1/FVC比值〕。所有患者进行支气管激发试验，记录FEV1下降20%时吸入乙酰胆碱的累积剂量（PD20-FEV1），以PD20-FEV1＜12.8 μmol为支气管激发试验阳性，提示气道高反应性，结合临床可诊断为哮喘。根据支气管激发试验结果将患者分为阳性组（n=65）和阴性组（n=85）。支气管舒张试验阴性的哮喘患者FeNO与PD20-FEV1的相关性分析采用Pearson相关分析。结果　阳性组FeNO、气流受限者占比高于阴性组，FEV1占预计值百分比和FEV1/FVC比值低于阴性组（P＜0.05）。Pearson相关分析结果显示，支气管舒张试验阴性的哮喘患者FeNO与PD20-FEV1呈负相关（r=-0.642，P＜0.001）。结论　支气管舒张试验阴性的哮喘患者FeNO升高，且FeNO与其PD20-FEV1呈负相关，推测FeNO升高对支气管舒张试验阴性的哮喘患者可能有一定诊断价值。

Abstract：

Objective To analyze the relationship between fractional exhaled nitric oxide (FeNO) and airwayresponsiveness in asthma patients with negative bronchial dilation test. Methods A total of 150 suspected asthma patients withnegative bronchial dilation test admitted to the Yan'an People's Hospital and Yan'an Hospital of Traditional Chinese Medicinefrom March 2019 to March 2022 were selected. The general data of the patients were collected, and FeNO and pulmonary functionindexes [including apercentage of forced expiratory volume in the first second (FEV1) to expected value, apercentage of forced vitalcapacity (FVC) to expected value, FEV1/FVC ratio] of the patients were measured. All patients underwent bronchial provocationtest, and provocation dosage causing a 20% decrease in FEV1 (PD20-FEV1) was recorded. Bronchial provocation test was positivewith PD20-FEV1 < 12.8 μmol, suggesting airway hyperresponsiveness, and combined with clinical practice, it can be diagnosedas asthma. According to the results of bronchial provocation test, the patients were divided into positive group (n=65) and negativegroup (n=85) . Pearson correlation analysis was used to analyze the correlation between FeNO and PD20-FEV1 in asthmaticpatients with negative bronchial dilation test. Results The FeNO and proportion of airflow limitation in the positive group werehigher than those in the negative group, apercentage of FEV1 to expected value and FEV1/FVC ratio were lower than those in thenegative group (P < 0.05) . Pearson correlation analysis showed that FeNO was negatively correlated with PD20-FEV1 in asthmaticpatients with negative bronchial dilation test (r=-0.642, P < 0.001) . Conclusion FeNO is elevated in asthma patients withnegative bronchial dilation test, and FeNO is negatively correlated with PD20-FEV1, so it is speculated that the elevation of FeNOmay have certain diagnostic value for asthma patients with negative bronchial dilation test.

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