中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2011年
11期
804-807
,共4页
王雯%黄克武%武宝梅%王艳军%王辰
王雯%黃剋武%武寶梅%王豔軍%王辰
왕문%황극무%무보매%왕염군%왕신
哮喘%痰嗜酸性粒细胞%呼出气一氧化氮
哮喘%痰嗜痠性粒細胞%呼齣氣一氧化氮
효천%담기산성립세포%호출기일양화담
Asthma%Sputum eosinophils%Exhaled nitricoxide
目的 分析诱导痰嗜酸性粒细胞(EOS)计数与第一秒用力呼气容积(FEV1)和呼出气一氧化氮浓度的关系,并探讨EOS和呼出气一氧化氮水平对治疗方案调整的指导意义.方法 收集轻-中度非急性发作期哮喘患者65例(轻度32例,中度33例),经吸入糖皮质激素和长效β2肾上腺素受体激动剂联合治疗1年,随访测定第一秒用力呼气容积占预计值百分比(FEV1％)、最高呼气流速占预计值百分比(PEF％)、诱导痰EOS计数和呼出气一氧化氮浓度,记录哮喘控制测试得分.同时测定21名健康志愿者(对照组)诱导痰EOS计数、FEV1％、PEF％及呼出气一氧化氮浓度.结果 共有63例患者完成治疗和随访全程.治疗1～3个月时患者肺功能恢复较快,治疗半年后肺功能仍有缓慢改善.在治疗第3个月时,呼出气一氧化氮水平下降[治疗前( 61±25) nmol/L,治疗3个月后(32±19)nmol/L],差异有统计学意义(q=7.32,P＜0.05)；治疗6个月时呼出气一氧化氮水平降至(22±12)nmoL/L,与治疗前及健康对照组比较差异有统计学意义(q=6.63,均P＜0.05)；哮喘组EOS计数为(0.093±0.023)×109/L,治疗3个月后为(0.032±0.0ll)×109/L,与治疗前及健康对照比较差异有统计学意义(均P ＜0.05)；半年内痰中EOS计数与呼出气一氧化氮水平呈正相关(均P＜0.05).l、3、6、9、12个月随访时FEV1与呼出气一氧化氮水平呈负相关(r1=-0.537,r3=-0.658,r6=-0.623,r9=-0.537,r12=-0.597,均P＜0.05).哮喘控制测试得分治疗前与治疗后l、3、6、9、12个月比较差异有统计学意义(F =5.72,P＜0.05).结论 诱导痰EOS与呼出气一氧化氮水平可以较为敏感反映哮喘患者气道炎症,可作为评价疗效及调整治疗方案的指标.
目的 分析誘導痰嗜痠性粒細胞(EOS)計數與第一秒用力呼氣容積(FEV1)和呼齣氣一氧化氮濃度的關繫,併探討EOS和呼齣氣一氧化氮水平對治療方案調整的指導意義.方法 收集輕-中度非急性髮作期哮喘患者65例(輕度32例,中度33例),經吸入糖皮質激素和長效β2腎上腺素受體激動劑聯閤治療1年,隨訪測定第一秒用力呼氣容積佔預計值百分比(FEV1％)、最高呼氣流速佔預計值百分比(PEF％)、誘導痰EOS計數和呼齣氣一氧化氮濃度,記錄哮喘控製測試得分.同時測定21名健康誌願者(對照組)誘導痰EOS計數、FEV1％、PEF％及呼齣氣一氧化氮濃度.結果 共有63例患者完成治療和隨訪全程.治療1～3箇月時患者肺功能恢複較快,治療半年後肺功能仍有緩慢改善.在治療第3箇月時,呼齣氣一氧化氮水平下降[治療前( 61±25) nmol/L,治療3箇月後(32±19)nmol/L],差異有統計學意義(q=7.32,P＜0.05)；治療6箇月時呼齣氣一氧化氮水平降至(22±12)nmoL/L,與治療前及健康對照組比較差異有統計學意義(q=6.63,均P＜0.05)；哮喘組EOS計數為(0.093±0.023)×109/L,治療3箇月後為(0.032±0.0ll)×109/L,與治療前及健康對照比較差異有統計學意義(均P ＜0.05)；半年內痰中EOS計數與呼齣氣一氧化氮水平呈正相關(均P＜0.05).l、3、6、9、12箇月隨訪時FEV1與呼齣氣一氧化氮水平呈負相關(r1=-0.537,r3=-0.658,r6=-0.623,r9=-0.537,r12=-0.597,均P＜0.05).哮喘控製測試得分治療前與治療後l、3、6、9、12箇月比較差異有統計學意義(F =5.72,P＜0.05).結論 誘導痰EOS與呼齣氣一氧化氮水平可以較為敏感反映哮喘患者氣道炎癥,可作為評價療效及調整治療方案的指標.
목적 분석유도담기산성립세포(EOS)계수여제일초용력호기용적(FEV1)화호출기일양화담농도적관계,병탐토EOS화호출기일양화담수평대치료방안조정적지도의의.방법 수집경-중도비급성발작기효천환자65례(경도32례,중도33례),경흡입당피질격소화장효β2신상선소수체격동제연합치료1년,수방측정제일초용력호기용적점예계치백분비(FEV1％)、최고호기류속점예계치백분비(PEF％)、유도담EOS계수화호출기일양화담농도,기록효천공제측시득분.동시측정21명건강지원자(대조조)유도담EOS계수、FEV1％、PEF％급호출기일양화담농도.결과 공유63례환자완성치료화수방전정.치료1～3개월시환자폐공능회복교쾌,치료반년후폐공능잉유완만개선.재치료제3개월시,호출기일양화담수평하강[치료전( 61±25) nmol/L,치료3개월후(32±19)nmol/L],차이유통계학의의(q=7.32,P＜0.05)；치료6개월시호출기일양화담수평강지(22±12)nmoL/L,여치료전급건강대조조비교차이유통계학의의(q=6.63,균P＜0.05)；효천조EOS계수위(0.093±0.023)×109/L,치료3개월후위(0.032±0.0ll)×109/L,여치료전급건강대조비교차이유통계학의의(균P ＜0.05)；반년내담중EOS계수여호출기일양화담수평정정상관(균P＜0.05).l、3、6、9、12개월수방시FEV1여호출기일양화담수평정부상관(r1=-0.537,r3=-0.658,r6=-0.623,r9=-0.537,r12=-0.597,균P＜0.05).효천공제측시득분치료전여치료후l、3、6、9、12개월비교차이유통계학의의(F =5.72,P＜0.05).결론 유도담EOS여호출기일양화담수평가이교위민감반영효천환자기도염증,가작위평개료효급조정치료방안적지표.
Objective To investigate the correlations between eosinophil counts in induced sputum and lung function (FENO) and evaluate these parameters in medication adjustment in patients with asthma.Methods Sixty-five outpatients with mild to moderate persistent asthma ( mild,32 ; moderate,33 ) from January to August 2008 were enrolled in the study.All were treated with combined medications comprising inhaled corticosteroids plus long-acting β2 agonists for 1 year.Lung function (FEV1％ and PEF％ ),eosinophil counts in induced sputum,FENO,and Asthma Control Test (ACT) scores were obtained at regular follow-up intervals.Twenty-one healthy volunteers served as controls,and lung function,eosinophil counts in induced sputum,and FENO were also obtained.Results Sixty-three subjects completed 1-year or longer follow-up.Lung function of 63 subjects recovered quickly in the early days and improved slowly during the following 6 months.FENO decreased from (61 ± 25 ) nmol/L at baseline to ( 32 ± 19 ) nmol/L by the third month (q =7.32,P＜0.05) and to (22 ± 12) nmol/L by the sixth month,which showed significant difference from normal controls [ ( 13 ± 8) nmol/L; q =6.63,P ＜ 0.05 ].Eosinophil counts in induced sputum of the asthma group at baseline were (0.093 ±0.023) × 109/L and decreased to (0.032 ±0.011)× 109/L by the third month,which was significantly different from baseline and normal controls [ (0.005 ±0.003) × 106/ml; q =5.49,P ＜0.05 and q =5.87,P ＜0.05,respectively].FENO showed a significantly positive correlation with eosinophil counts in induced sputum in the first 6 months (r1 =0.612,r2 =0.558,r3 =0.675; all P＜0.05) and a negative correlation with FEV1 (r1 =-0.537,r3 =-0.658,r6 ＝ -0.623,r9 =-0.537,r12 =-0.597 ; all P ＜0.05 ) at any time point of the study.The ACT score of 63 subjects at baseline was 14 ±3,and the scores after treatment for 1,3,6,9,and 12 months were 18 ±5,19 ±7,23 ±2,24 ± 1,and 24 ± 1,respectively; at the same time,significant difference was found ( F =5.72,P ＜ 0.05).Effectiveness was found according to the ACT score only 1 month after treatment.Conclusion The parameters of FENO and eosinophil counts in induced sputum were sensitive in the detection of airway inflammation and may be useful in evaluation of the efficacy of treatment and adjustment of medication regimens.
