呼出气一氧化氮测定在指导慢性阻塞性肺疾病急性加重患者使用全身激素的价值

doi:10.3969/j.issn.1000-8535.2023.10.008

摘要/Abstract

摘要： 目的探析慢性阻塞性肺疾病急性加重（AECOPD）患者在全身糖皮质激素（激素）使用过程中检测呼出气一氧化氮（FeNO）的价值。方法于2019年1月—2021年12月梅州市人民医院采集病例展开随机对照研究,实施对象为58例AECOPD患者,均检测FeNO水平,根据FeNO水平是否>25 ppb,分组为FeNO高水平组和FeNO低水平组,根据是否接受全身激素治疗分为治疗组和对照组,对照组予以常规治疗,治疗组实行常规+全身激素治疗;检测治疗前后FeNO、肺功能指标水平变化,判定COPD评估测试（CAT）评分,对比组间差异。结果 FeNO高水平组全身激素治疗后（治疗组）FeNO降低（P<0.05）,高水平组常规治疗后（对照组）FeNO前后比较差异无统计学意义（P>0.05）,低水平组中治疗组和对照组治疗前后FeNO比较差异无统计学意义（P>0.05）;FeNO高水平组治疗后第一秒用力呼气容积（FEV₁）、第一秒用力呼气量占用力肺活量比值（FEV₁/FVC）均升高,且治疗组升高程度较对照组更大（均P<0.05）,FeNO低水平组治疗后FEV₁、FEV₁/FVC均升高（均P<0.05）,但治疗组与对照组相比无差异（P>0.05）;FeNO高水平组、低水平组治疗后CAT评分较治疗前均下降（均P<0.05）,FeNO高水平组下降更明显。结论 AECOPD患者实施FeNO测定,其水平变化在一定程度上可反映气道炎症,并预测激素治疗反应,指导合理有效地应用全身激素,避免出现激素过度使用情况。

关键词: 呼出气一氧化氮测定, 慢性阻塞性肺疾病, 急性加重, 全身激素

Abstract: Objective To explore the value of detecting exhaled nitric oxide(FeNO)during systemic glucocorticoid use in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A randomized controlled study was conducted from January 2019 to December 2021 at the People's Hospital of Meizhou City. The subjects were 58 AECOPD patients,all of whom were tested for FeNO levels. Based on whether the FeNO levels were>25 ppb,they were divided into a high level FeNO group and a low level FeNO group. They were divided into a treatment group and a control group based on whether they received systemic glucocorticoid therapy. The control group received routine treatment,while the treatment group received routine and systemic glucocorticoid therapy. Changes in FeNO and lung function indicators before and after treatment were detected,COPD assessment test(CAT)scores were determined,and differences between groups were compared. Results After systemic glucocorticoid therapy,the high level group of FeNO showed a decrease in FeNO(P<0. 05),while the high level group showed no statistically significant difference in FeNO before and after routine treatment(P>0. 05). The low level group showed no statistically significant difference in FeNO between the treatment group and the control group before and after treatment(P>0. 05). The first second forced expiratory volume(FEV₁)and the ratio of first second forced expiratory volume to forced vital capacity(FEV₁/FVC)in the high level group of FeNO significantly increased after treatment,and the degree of increase in the treatment group was greater than that in the control group(all P<0. 05). The FEV₁ and FEV₁/FVC in low level group of FeNO significantly increased after treatment(all P<0. 05),but the difference between the treatment group and the control group was not significant(P>0. 05). The CAT scores of the high and low levels of FeNO groups decreased after treatment compared to before treatment(all P<0. 05),and the decrease was more significant in the high level FeNO group. Conclusions The implementation of FeNO measurement in AECOPD patients can reflect airway inflammation to a certain extent,predict glucocorticoid treatment response,guide the rational and effective application of systemic glucocorticoid and avoid excessive glucocorticoid use.

Key words: exhaled nitric oxide measurement, chronic obstructive pulmonary disease, acute exacerbation, systemic glucocorticoid

罗红辉, 刘育良, 古晓龙, 黄聪, 罗忆群. 呼出气一氧化氮测定在指导慢性阻塞性肺疾病急性加重患者使用全身激素的价值[J]. 广州医药, 2023, 54(10): 58-62.

LUO Honghui, LIU Yuliang, GU Xiaolong, HUANG Cong, LUO Yiqun. Value of exhaled nitric oxide measurement in guiding the use of systemic glucocorticoid in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Guangzhou Medical Journal, 2023, 54(10): 58-62.

参考文献

[1] 汪浩,丁震.呼出气一氧化氮测定在AECOPD患者吸入激素治疗中的价值[J].临床肺科杂志,2018,23(3):473-476.
[2] 王晶,郭伟,侯丽萍,等.FeNO与IL-6指导AECOPD患者应用糖皮质激素治疗的临床研究[J].中国免疫学杂志,2021,37(5):595-599.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组,中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会.慢性阻塞性肺疾病诊治指南(2021年修订版)[J].中华结核和呼吸杂志,2021,44(3):36.
[4] 郑忠生,蔡举瑜,叶铭植,等.呼出气一氧化氮测定在哮喘-慢性阻塞性肺疾病重叠综合征诊疗中的应用[J].广东医学,2019,40(s1):145-147,152.
[5] 郭晓珍,林晓敏,涂智毅,等.呼出气一氧化氮浓度测定在慢性阻塞性肺疾病急性加重病情评估中的意义[J].中国医学创新,2019,16(12):136-139.
[6] 赵佳佳,刘笑琴,查日田.呼出气一氧化氮及同型半胱氨酸对慢性阻塞性肺疾病急性加重期并发肺动脉高压患者的临床诊断价值[J].徐州医科大学学报,2021,41(9):656-660.
[7] 罗红辉,刘育良,黄聪.呼出气一氧化氮在慢性阻塞性肺疾病急性加重期患者中的表达水平及临床意义[J].中国当代医药,2021,28(6):61-63.
[8] 朱红国,郏丽娜,张天翼,等.慢性阻塞性肺疾病PM2.5暴露水平与呼出气一氧化氮(FeNO)水平相关性研究[J].中国卫生检验杂志,2019,29(6):691-693.
[9] 赵爽,徐建华,王导新,等.呼出气一氧化氮联合激活蛋白A测定对哮喘-慢性阻塞性肺疾病重叠的诊断价值[J].医学综述,2020,26(8):1608-1613.
[10] 谢昭鑫. 慢性阻塞性肺疾病患者病期与呼出气一氧化氮(FENO)、肺功能水平的相关性研究[J].吉林医学,2019,40(9):1973-1975.
[11] 魏俊,丁亚萍,朱家宁.动态测定呼出气一氧化氮与降钙素原预测吸入糖皮质激素治疗AECOPD患者的价值[J].哈尔滨医科大学学报,2022,56(4):378-382.
[12] 吴成明,雷撼,胡云倩,等.呼出气一氧化氮测定预测吸入性糖皮质激素对慢性阻塞性肺疾病治疗效果的价值研究[J].临床和实验医学杂志,2018,17(12):1332-1335.
[13] 黎艳聪,李付艺.呼出气一氧化氮测定在评估慢性阻塞性肺疾病中的作用[J].中国实用医药,2020,15(25):7-9.
[14] 翟豫疆,李风森,徐倩.COPD急性加重期患者FENO与肺功能等相关性分析[J].新疆医科大学学报,2012,35(10):1304-1307.

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