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 对比羟氯喹联合半量激素与足量糖皮质激素（激素）治疗IgA肾病在减少尿蛋白、保护肾功能方面的效果以及不良反应的发生率。方法 筛选2020年6月—2022年1月我院收治基线尿蛋白排泄量>1 g/ d、基线估算肾小球滤过率>15 mL/min的IgA肾病患者为研究对象,随机分为羟氯喹+半量激素（Q+G）组及足量激素（G）组。Q+G组予羟氯喹及泼尼松0.5 mg/（kg·d）,G组予泼尼松 1 mg/（kg·d）,比较2组在治疗2、4、6个月后24 h尿蛋白定量的改变值;比较2组6个月内24 h尿蛋白较基线下降>30%的比例、24 h尿蛋白定量下降至1 g以下的比例、估算肾小球滤过率下降>30%的比例以及不良反应发生率。结果 纳入Q+G组49例,G组46例。2组在治疗2、4、6个月后的24 h尿蛋白定量改变值、6个月内24 h尿蛋白较基线下降>30%的比例、24 h尿蛋白定量下降至1 g以下的比例、6个月内估算肾小球滤过率下降>30%的比例比较差异均无统计学意义（均P>0.05）;Q+G组不良反应发生率低于G组（P<0.05）。结论 与足量激素治疗相比,羟氯喹联合半量激素治疗尿蛋白持续>1 g/d的IgA肾病患者在减少尿蛋白、保护肾功能中的效果相近,而不良反应的发生率较低。

Objective Compared with full-dose glucocorticoid,to evaluate the effect of hydroxychloroquine combined with half-dose glucocorticoid in the treatment of IgA nephropathy in reducing urinary protein and protecting renal function,as well as the incidence of adverse reactions. Methods From June 2020 to January 2022,patients with IgA nephropathy whose baseline urinary protein excretion>1 g/d and baseline estimate glomerular filtration rate>15 mL/min were enrolled and randomly divided into hydroxychloroquine combined with half-dose glucocorticoid(Q+G)group and full-dose glucocorticoid(G)group. Each patient in Q+G group was given oral hydroxychloroquine and oral prednisone at a dose of 0. 5 mg/(kg·d). Each patient in G group was given prednisone at a dose of 1 mg/(kg·d). The changes in 24-hour urine protein quantification between the two groups at 2,4 and 6 months of treatment were compared;the proportions of 24-hour urine protein decreased by more than 30%,24-hour urine protein decreased to less than 1 g,estimate glomerular filtration rate decreased >30% and adverse reactions within 6 months were compared between the two groups. Results Fourty-nine cases were enrolled in Q+G group and 46 cases in G group. There was no significant difference in the 24-hour urine protein changes between the two groups at 2,4 and 6 months of treatment. The proportion of 24-hour urine protein decreased by 30%,the proportion of the 24-hour urine protein decreased to below 1 g and the proportions of patients whose estimate glomerular filtration rate decreased by >30% within 6 months between the two groups were not significantly different. The proportion of adverse reactions in Q+G group was lower than that in G group. Conclusions Hydroxychloroquine combined with half-dose glucocorticoid has similar effects in reducing urinary protein and protecting renal function and lowering incidence of adverse reactions compared with full-dose glucocorticoid therapy in the treatment of patients with IgA nephropathy whose urinary protein excretion > 1 g/d.