呼出氣一氧化氮對成人支氣管哮喘治療的指導作用_《中國呼吸與危重監護雜志》

作者：

1. 中國醫學科學院北京協和醫院呼吸內科(北京 100730);;
2. 首都醫科大學大興醫院呼吸內科(北京 102600);

關鍵詞：

呼出氣一氧化氮哮喘 ACT評分肺功能

DOI：

10.7507/1671-6205.2014031

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目的探討呼出氣一氧化氮測定對成人支氣管哮喘治療的指導作用。方法選取在北京協和醫院門診就診的64例哮喘患者,所有患者進行哮喘控制測試(ACT)調查表的填寫及呼出氣一氧化氮(FeNO)、肺功能測定,記錄FeNO值及第1秒用力呼氣容積(FEV₁)、第1秒用力呼氣容積占預計值百分比(FEV₁% pred),根據FeNO值分為FeNO增高組(n=33)和FeNO正常組(n=31),兩組患者均給予長效β₂受體激動劑/吸入性皮質激素(ICS/LABA,沙美特羅替卡松50/250)規律治療,3個月后隨診,復測肺功能、FeNO,填寫ACT評分量表。結果兩組患者治療后ACT評分較治療前均有明顯改善,FeNO增高組ACT評分高于FeNO正常組(22.07±5.49比19.23±5.48,t=2.893,P＜0.05),FeNO增高組完全控制率高于FeNO正常組(42.42%比19.35%,χ²=3.960,P＜0.05);FEV₁、FEV₁%pred兩組較治療前均有明顯改善,FeNO增高組治療后FEV₁、FEV₁%pred均高于FeNO正常組,但差異無統計學意義。FeNO、FeNO改善率與治療前ACT評分呈負相關(r=-0.302,P＜0.05;r=0.674,P＜0.01),與治療后ACT改善值呈正相關(r=0.514,P＜0.01;r=0.674,P＜0.01)。FeNO及FeNO改善率與治療前后FEV₁、FEV₁%pred均無相關性。結論吸入ICS/LABA對FeNO增高的支氣管哮喘患者療效較好,FeNO值越高吸入ICS/LABA后臨床癥狀改善越明顯,FeNO可用于預測哮喘患者對吸入ICS/LABA治療的敏感性,指導哮喘臨床治療。

引用本文： 劉霞, 許文兵, 劉亞男, 趙陽, 孟淑珍. 呼出氣一氧化氮對成人支氣管哮喘治療的指導作用. 中國呼吸與危重監護雜志, 2013, 12(2): 120-124. doi: 10.7507/1671-6205.2014031 復制

1.	Bateman ED,Hurd SS,Barnes PJ,et al.Global strategy for asthma management and prevention: GINA executive summary.Eur Respir J,2008,31:143-178.
2.	ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med, 2005,171:912-930.
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4.	Donohue JF,Jain N.Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates.Respir Med,2013,107:943-952.
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7.	Delgado-Corcoran C,Kissoon N,Murphy SP,et al.Exhaled nitric oxide reflects asthma severity and asthma control.Pediatr Crit Care Med,2004,5: 48-52.
8.	龔穎,葉伶,安霞,等.評估呼出氣一氧化氮(FeNO)在支氣管哮喘管理中的作用.復旦大學學報:醫學版,2013,40:349-353.
9.	Waibel V,Ulmer H,Horak E.Assessing asthma control: symptom scores,GINA levels of asthma control,lung function,and exhaled nitric oxide.Pediatr Pulmonol,2012,47:113-118.
10.	李瑞,趙海金,蔡紹曦,等.支氣管哮喘患者呼出氣一氧化氮、肺功能、ACQ7評分之間的相關性研究.中華哮喘雜志:電子版,2012,6:151-155.
11.	Perez-de-LIano LA,Carballada F,Castro Anon O,et al.Exhaled nitrie oxide predicts control in patients with difficult-to-treat asthma.Eur Respir J,2010,35: 1221-1227.
12.	Smith AD,cowan JO,brassrtt KP,et al.Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.N Engl J Med,2005,352: 2163 2173.
13.	Hewitt RS,Modrich CM,Cowan JO,etal.Outcomes using exhaled nitric oxide measurements as an adjunct to primary care asthma management.Prim Care Respir J,2009,18:320-332.
14.	Szefler SJ,Mitehell H,Sorknes CA,et al.Management of asthma based on exhaled nitric oxide in addition to guide line based treatment for inner-city adolescents and young adults: a randomised controlled trial.Lancet,2008,372: 1065-1072.
15.	Jartti T,Wendelin-Saarenhovi M, Heinonen I,et al.Childhood asthma management guided by repeated FENO measurements: a meta-analysis.Paediatr Respir Rev,2012,13:178-183.
16.	Petsky HL,Cates CJ,Li A,etal.Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults.Cochrane Database Syst Rev,2009,7 (4):CD006340.
17.	Pike K,Selby A,Price S,et al.Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial.Clin Respir J,2012[Epub ahead of print].

1. Bateman ED,Hurd SS,Barnes PJ,et al.Global strategy for asthma management and prevention: GINA executive summary.Eur Respir J,2008,31:143-178.
2. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med, 2005,171:912-930.
3. Liu L,Urban P,Hunt JF,et al.Changes in exhaled nitric oxide and breath pH during fluticasone wean in asthma.Respiration,2010,79:193-199.
4. Donohue JF,Jain N.Exhaled nitric oxide to predict corticosteroid responsiveness and reduce asthma exacerbation rates.Respir Med,2013,107:943-952.
5. Cowan DC,Hewitt RS,Cowan JO,et al.Exercise-induced wheeze: Fraction of exhaled nitric oxide-directed management.Respirology,2010,15:6836-6890.
6. Scott M,Raza A,Karmaus W,et al.Influence of atopy and asthma on exhaled nitric oxide in an unselected birth cohort study.Thorax,2010,65:258-262.
7. Delgado-Corcoran C,Kissoon N,Murphy SP,et al.Exhaled nitric oxide reflects asthma severity and asthma control.Pediatr Crit Care Med,2004,5: 48-52.
8. 龔穎,葉伶,安霞,等.評估呼出氣一氧化氮(FeNO)在支氣管哮喘管理中的作用.復旦大學學報:醫學版,2013,40:349-353.
9. Waibel V,Ulmer H,Horak E.Assessing asthma control: symptom scores,GINA levels of asthma control,lung function,and exhaled nitric oxide.Pediatr Pulmonol,2012,47:113-118.
10. 李瑞,趙海金,蔡紹曦,等.支氣管哮喘患者呼出氣一氧化氮、肺功能、ACQ7評分之間的相關性研究.中華哮喘雜志:電子版,2012,6:151-155.
11. Perez-de-LIano LA,Carballada F,Castro Anon O,et al.Exhaled nitrie oxide predicts control in patients with difficult-to-treat asthma.Eur Respir J,2010,35: 1221-1227.
12. Smith AD,cowan JO,brassrtt KP,et al.Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.N Engl J Med,2005,352: 2163 2173.
13. Hewitt RS,Modrich CM,Cowan JO,etal.Outcomes using exhaled nitric oxide measurements as an adjunct to primary care asthma management.Prim Care Respir J,2009,18:320-332.
14. Szefler SJ,Mitehell H,Sorknes CA,et al.Management of asthma based on exhaled nitric oxide in addition to guide line based treatment for inner-city adolescents and young adults: a randomised controlled trial.Lancet,2008,372: 1065-1072.
15. Jartti T,Wendelin-Saarenhovi M, Heinonen I,et al.Childhood asthma management guided by repeated FENO measurements: a meta-analysis.Paediatr Respir Rev,2012,13:178-183.
16. Petsky HL,Cates CJ,Li A,etal.Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults.Cochrane Database Syst Rev,2009,7 (4):CD006340.
17. Pike K,Selby A,Price S,et al.Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial.Clin Respir J,2012[Epub ahead of print].

《中國呼吸與危重監護雜志》

呼出氣一氧化氮對成人支氣管哮喘治療的指導作用

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《中國呼吸與危重監護雜志》

呼出氣一氧化氮對成人支氣管哮喘治療的指導作用

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