呼出气一氧化氮检测在哮喘-慢阻肺重叠综合征治疗中的应用价值

目的 探讨呼出气一氧化氮（FeNO）测定在哮喘-慢阻肺重叠综合征（ACOS）治疗中的应用价值。方法 收集2015年5月至2015年10月在苏州九龙医院确诊但未规范使用药物治疗的ACOS患者28例，给予为期12周的吸入性糖皮质激素/长效β受体激动剂（ICS/LABA）吸入治疗，检测治疗前后患者的FeNO值、FEV1% pred、诱导痰嗜酸粒细胞（EOS）、血清总IgE、超敏C反应蛋白（hs-CRP）的水平；Pearson相关系数法分析FeNO值与其他指标的相关性。将患者按不同年龄和吸烟状况进行分组，比较各组患者在治疗前后各项指标的变化。同时选取28例健康受试者作为对照，检测其FeNO水平。结果 治疗前、后ACOS患者的FeNO水平[（32.04±8.34）×10-9 mol/L vs（25.56±4.13）×10-9 mol/L，P<0.05]、诱导痰EOS[（18.51±5.36）% vs（13.18±1.56）%，P<0.05]、血清总IgE[（251.91±42.24）ng/mL vs（204.65±28.52）ng/mL，P<0.05]差异有统计学意义；而FEV1% pred[（52.03±7.03）% vs（55.16±8.20）%，P=0.391]、hs-CRP水平[（10.86±4.92）mg/L vs（9.16±1.82）mg/L，P=0.077]差异无统计学意义。治疗前、后ACOS组患者的FeNO水平均高于健康对照组[（32.04±8.34）×10-9 mol/L、（25.56±4.13）×10-9 mol/L vs（17.04±0.97）×10-9 mol/L，P<0.05]。不同年龄和吸烟状况的患者在ICS/LABA治疗前、后的FeNO值、诱导痰EOS、血清总IgE差异也均有统计学意义。ICS/LABA吸入治疗前、后ACOS组患者的FeNO水平与诱导痰EOS、血清总IgE均呈正相关（治疗前：r=0.924，P<0.01；r=0.945，P<0.01。治疗后：r=0.247，P<0.01；r=0.443，P<0.01），而与血清hs-CRP、FEV1% pred则无相关性。结论 ACOS患者气道存在EOS性炎症，可使用ICS/LABA吸入治疗，其疗效不受年龄及吸烟状况的影响。FeNO检测可作为检测和评估ACOS使用ICS/LABA治疗疗效的有效手段，且其与诱导痰EOS、血清总IgE相关。
Objective To investigate the value of fractional exhaled nitric oxide (FeNO) in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Methods The twenty-eight ACOS patients receiving no standard medication treatment were recruited from May 2015 to Oct. 2015 in Suzhou Kowloon Hospital; the patients inhaled corticosteroids/long-acting beta agonist (ICS/LABA) for 12 weeks and the changes of FeNO levels, FEV1%pred, induced sputum eosinophil (EOS), blood total IgE, and high sensitivity C-reactive protein (hs-CRP) were examined before and after treatment. The correlations between FeNO and other indices were analyzed by Pearson correlation coefficient method. The patients were divided into different groups according to different age and smoking statuses, and the changes of the indices before and after treatment were compared between different groups. Twenty-eight healthy participants were recruited as control group and their FeNO levels were also tested. Results After treatment, the FeNO levels ([32.04±8.34]×10-9 mol/L vs[25.56±4.13]×10-9 mol/L, P<0.05), induced sputum EOS ([18.51±5.36]% vs[13.18±1.56]%, P<0.05), and blood total IgE ([251.91±42.24] ng/mL vs[204.65±28.52] ng/mL, P<0.05) of ACOS patients were significantly lower than those before treatment. There was no significant difference in FEV1%pred ([52.03±7.03]% vs[55.16±8.20]%, P=0.391) or hs-CRP ([10.86±4.92] mg/L vs[9.16±1.82) mg/L, P=0.077) before and after treatment in ACOS patients. Meanwhile, the levels of FeNO in ACOS