糖皮质激素吸入治疗亚急性咳嗽患者呼出气一氧化氮测定及临床意义
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四川省卫生厅科研课题(120116)


Determination of FENO and clinic significance of ICS in treating sub acute cough
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    摘要:

    【摘要】 目的 探讨检测呼出气一氧化氮(fractional exhaled nitric oxide,FENO)在亚急性咳嗽吸入糖皮质激素(ICS)治疗疗效评价中的作用,进而发现FENO在亚急性咳嗽诊断和治疗中的价值。方法 收集2015年3月~10月亚急性咳嗽患者200例,根据病因分成感染后咳嗽组95例(PIC)、咳嗽变异性哮喘组45例(CVA)、嗜酸细胞性支气管炎组30例(EB)、上气道咳嗽综合征组15例(UACS)、胃食管反流性咳嗽组(GERC)组5例、双病因组10例,评估患者咳嗽症状程度、FENO 值、肺通气功能以及治疗反应性。结果 亚急性咳嗽中PIC组的FENO水平12(732)ppb低于CVA组205(1332)ppb(Z=-3385,P<001),同时也低于EB组22(1235)ppb(Z=-3732,P<001);但 PIC 组的FENO水平分别高于UACS组7(69)ppb(Z=-3011,P<001)、GERC组35(34)ppb(Z=-2115,P<005)、双病因组7(69)ppb(Z=-2336,P<001);而CVA组与EB组的FENO水平无显著差别(Z=-0739,P=0341);各病因组中,相对于 CVA 组FEV1(8819±1780)%,PIC组(11035±1436)%和EB组(10763±1429)%均显著升高,P<005;MMEF pred%在PIC组(9624±1727)%和EB组(9812±1472)%显著高于CVA组(5836±1667)%,P<001;FVC pred%和FEV1/FVC%在各病因组间差异不明显,差异无统计学意义(P>005);EB组诱导痰嗜酸粒细胞比例低于CVA组,CVA组、EB组的均显著高于其他病因组(P<001);结果显示 FENO 水平与痰嗜酸性粒细胞百分比存在显著正相关(R=0928,P<0001)。结论 糖皮质激素吸入治疗对亚急性咳嗽患者有一定的临床效果,支持 FENO 作为亚急性咳嗽经验性吸入激素治疗的重要参考指标,FENO≥19ppb可以作为预测疗效的衡量标准之一。

    Abstract:

    【Abstract】 Objective To investigate the influence of FENO on sub acute cough treated by ICS and then observe the value of it on diagnose and treatment of sub acute cough. Methods 200 patients with sub acute cough in our hospital from March 2015 to October 2015 were divided into PIC group, CVA group, EB group, UACS group, GERC group and double causes group. The cough degree, FENO, pulmonary ventilation function and treatment response were observed. Results FENO level of PIC group [12(732)ppb] was lower than that of CVA group [205(1332)ppb(Z=-3385,P<001)] and EB group [ 22(1235)ppb(Z=-3372,P<001)]. FENO level of PIC group was higher than that of UACS group [7(69)ppb(Z=-3011,P<001)], GERC group [35(34)ppb(Z=-2115,P<005)] and double causes group [7(69)ppb(Z=-2336,P<001)]. FENO level of CVA group and EB group had not obvious difference (Z=-0739,P=0341). Compared with that of CVA group, FEV1 of PIC group and EB group were obviously increased (P<005). MMEF pred% in PIC group (9624±1727)% and EB group (9812±1472)% were obviously higher than that of CVA group (5836±1667)%, P<001. FVC pred% and FEV1/FVC% had no obvious difference between each group( P>005). Induced sputum oxyphil cell rate of EB group was lower than that of CVA group. nduced sputum oxyphil cell rate of CVA group and EB group were obviously higher than that of other groups (P<001). The results showed that, FENO level and suptum eosinophil cell percentage had obvious positive correlation (R=0928,P<0001). Conclusion Using FENO≥19ppb as a standard can predict reflection of ICS on cough condition. FENO should be supported as important reference index on ICS therapy.

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  • 在线发布日期: 2017-05-22
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