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。

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.

目的 研究结核感染T细胞斑点试验(T-SPOT.TB)技术联合胸水腺苷脱氨酶(ADA)在结核性胸膜炎中的诊断价值。方法 在研究中选取2016年1月—2018年12月在梅州市人民医院呼吸内科和全科医学科住院的60例结核性胸膜炎患者作为研究对象,对所有患者均进行血T-SPOT.TB、胸水ADA检查,比较血T-SPOT.TB、胸水ADA及胸水ADA联合血T-SPOT.TB检查三种检测方式的诊断符合率、误诊率、漏诊率、阳性预测值、阴性预测值、准确性、特异度、敏感度。结果 胸水ADA、血T-SPOT.TB以及血T-SPOT.TB联合胸水ADA检测方式的诊断符合率分别为75%、80.00%、93.33%,联合检测方式的诊断符合率高于单一检测方式的诊断符合率(P＜0.05)。血T-SPOT.TB联合胸水ADA检测方式的误诊率、漏诊率分别为0.00%、1.72%,低于胸水ADA、T-SPOT.TB检测方式(P＜0.05);血T-SPOT.TB联合胸水ADA检测方式的阳性预测值、阴性预测值分别为100.00%,67.78%,联合检测方式的阴性预测值高于其单一检测方式(P＜0.05)。T-SPOT.TB联合胸水ADA检测方式的特异度及敏感度分别为98.79%、97.87%,联合检测方式的敏感度高于其单一检测方式(P＜0.05)。血T-SPOT.TB检测方式与胸水ADA检测方式仅在特异度方面不存在统计学差异(P＞0.05)。结论 在对结核性胸膜炎患者进行诊断时,血T-SPOT.TB联合胸水ADA具有较高的诊断价值,值得应用。

Objective To investigate the diagnostic value of t-spot test (T-SPOT.TB) combined with adenosine deaminase (ADA) in tuberculous pleuritis. Methods 60 patients with tuberculous pleurisy hospitalized in the departments of respiratory medicine and general practice of Meizhou People's Hospital between January 2016 and December 2018 were enrolled in the study. All the patients were examined by blood T-SPOT.TB and ADA. The diagnostic coincidence rate, false positive rate,false negative rate, positive predictive value, negative predictive value, accuracy, specificity and sensitivity of the three detection methods of T-SPOT.TB, ADA, and T-SPOT.TB combined with ADA were also analyzed. Results The diagnostic coincidence rate of ADA, T-SPOT.TB and T-SPOT.TB combined with ADA was 75%, 80.00% and 93.33%, respectively. The diagnostic coincidence rate of the combined test was higher than that of the detection method (P<0.05). The misdiagnosis rate and missed diagnosis rate of blood T-SPOT.TB combined with ADA were 33.3% and 1.75%, respectively. The positive predictive value and negative predictive value of blood T-SPOT.TB combined with ADA test were 98.2% and 66.6%, respectively. The negative predictive value of combined T-SPOT.TB combined with ADA test was higher than that of the single test (P<0.05). The specificity and sensitivity of the T-SPOT.TB combined with ADA were 98.79% and 97.87%, respectively, and the sensitivity of the combined test was higher than that of the single test (P<0.05). Conclusion Blood T-SPOT.TB combined with pleural effusion ADA has higher diagnostic value in patients with tuberculous pleurisy and is worthy of clinical application.