呼出气一氧化氮对成人支气管哮喘治疗的指导作用_《中国呼吸与危重监护杂志》

作者：

1. 中国医学科学院北京协和医院呼吸内科(北京 100730);;
2. 首都医科大学大兴医院呼吸内科(北京 102600);

关键词：

呼出气一氧化氮哮喘 ACT评分肺功能

DOI：

10.7507/1671-6205.2014031

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨呼出气一氧化氮测定对成人支气管哮喘治疗的指导作用。方法选取在北京协和医院门诊就诊的64例哮喘患者,所有患者进行哮喘控制测试(ACT)调查表的填写及呼出气一氧化氮(FeNO)、肺功能测定,记录FeNO值及第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积占预计值百分比(FEV₁% pred),根据FeNO值分为FeNO增高组(n=33)和FeNO正常组(n=31),两组患者均给予长效β₂受体激动剂/吸入性皮质激素(ICS/LABA,沙美特罗替卡松50/250)规律治疗,3个月后随诊,复测肺功能、FeNO,填写ACT评分量表。结果两组患者治疗后ACT评分较治疗前均有明显改善,FeNO增高组ACT评分高于FeNO正常组(22.07±5.49比19.23±5.48,t=2.893,P＜0.05),FeNO增高组完全控制率高于FeNO正常组(42.42%比19.35%,χ²=3.960,P＜0.05);FEV₁、FEV₁%pred两组较治疗前均有明显改善,FeNO增高组治疗后FEV₁、FEV₁%pred均高于FeNO正常组,但差异无统计学意义。FeNO、FeNO改善率与治疗前ACT评分呈负相关(r=-0.302,P＜0.05;r=0.674,P＜0.01),与治疗后ACT改善值呈正相关(r=0.514,P＜0.01;r=0.674,P＜0.01)。FeNO及FeNO改善率与治疗前后FEV₁、FEV₁%pred均无相关性。结论吸入ICS/LABA对FeNO增高的支气管哮喘患者疗效较好,FeNO值越高吸入ICS/LABA后临床症状改善越明显,FeNO可用于预测哮喘患者对吸入ICS/LABA治疗的敏感性,指导哮喘临床治疗。

引用本文： 刘霞, 许文兵, 刘亚男, 赵阳, 孟淑珍. 呼出气一氧化氮对成人支气管哮喘治疗的指导作用. 中国呼吸与危重监护杂志, 2013, 12(2): 120-124. doi: 10.7507/1671-6205.2014031 复制

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.
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.	龚颖,叶伶,安霞,等.评估呼出气一氧化氮(FeNO)在支气管哮喘管理中的作用.复旦大学学报:医学版,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,赵海金,蔡绍曦,等.支气管哮喘患者呼出气一氧化氮、肺功能、ACQ7评分之间的相关性研究.中华哮喘杂志:电子版,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. 龚颖,叶伶,安霞,等.评估呼出气一氧化氮(FeNO)在支气管哮喘管理中的作用.复旦大学学报:医学版,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,赵海金,蔡绍曦,等.支气管哮喘患者呼出气一氧化氮、肺功能、ACQ7评分之间的相关性研究.中华哮喘杂志:电子版,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].

《中国呼吸与危重监护杂志》

呼出气一氧化氮对成人支气管哮喘治疗的指导作用

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《中国呼吸与危重监护杂志》

呼出气一氧化氮对成人支气管哮喘治疗的指导作用

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