CAJ | 학술논문

目的：探讨分析呼出气一氧化氮(Fractional exhaled Nitric Oxide，FeNO)与乙酰甲胆碱(methacholine)支气管激发试验(bronchial provocation test，BPT)能否反应哮喘控制程度及二者的相关性分析，评估二者在支气管哮喘诊断及疗效评价方面的临床价值。方法：选取2012.1-2013.10新乡市中心医院呼吸内科门诊支气管哮喘非急性发作期患者42例参加本研究测试，并根据《全球哮喘防治创议》2009方案非急性发作期哮喘控制状态分级标准分为控制组16例，部分控制组14例，未控制组12例。设正常对照组18例。首先进行呼出气一氧化氮测试，然后进行肺通气功能测试，最后进行乙酰甲胆碱支气管激发试验。应用FEV1（第1秒钟用力呼气容积）下降20%时乙酰甲胆碱的药物激发浓度（PC20）评价气道反应性。应用FeNO评价气道炎症。观察测试中间出现的不良反应。结果：参加测试者共60人，测试中间有7例退出。最终有哮喘控制组15例，部分控制组13例，未控制组10例，正常对照组15例完成呼出气一氧化氮、肺通气功能测试和乙酰甲胆碱支气管激发试验。哮喘控制组，部分控制组，未控制组FeNO结果、BPT 对数转换PC20(lnPC20)与正常对照组均有显著差异，有统计学意义，P＜0.05。哮喘控制组，部分控制组，未控制组用力肺活量结果与正常对照组无显著差异，无统计学意义，P＞0.05。直线相关分析结果显示：控制组、部分控制组、未控制组FeNO和支气管激发试验药物激发浓度lnPC20均有直线相关性，为负相关。（分别为r=-0.971,P＜0.05；r=-0.948,P＜0.05； r=-0.969,P＜0.05）结论：1.评估哮喘控制状态需综合评定，不能单纯用呼出气一氧化氮结果来评定。2.呼出气一氧化氮与支气管激发试验PC20呈负相关。呼出气一氧化氮反映的气道炎症与支气管激发试验反映的气道反应性呈正相关。3.在临床诊断及疗效评价方面，呼出气一氧化氮可部分取代支气管激发试验评价支气管哮喘患者的气道炎症及气道高反应性。目的：探討分析呼齣氣一氧化氮(Fractional exhaled Nitric Oxide，FeNO)與乙酰甲膽堿(methacholine)支氣管激髮試驗(bronchial provocation test，BPT)能否反應哮喘控製程度及二者的相關性分析，評估二者在支氣管哮喘診斷及療效評價方麵的臨床價值。方法：選取2012.1-2013.10新鄉市中心醫院呼吸內科門診支氣管哮喘非急性髮作期患者42例參加本研究測試，併根據《全毬哮喘防治創議》2009方案非急性髮作期哮喘控製狀態分級標準分為控製組16例，部分控製組14例，未控製組12例。設正常對照組18例。首先進行呼齣氣一氧化氮測試，然後進行肺通氣功能測試，最後進行乙酰甲膽堿支氣管激髮試驗。應用FEV1（第1秒鐘用力呼氣容積）下降20%時乙酰甲膽堿的藥物激髮濃度（PC20）評價氣道反應性。應用FeNO評價氣道炎癥。觀察測試中間齣現的不良反應。結果：參加測試者共60人，測試中間有7例退齣。最終有哮喘控製組15例，部分控製組13例，未控製組10例，正常對照組15例完成呼齣氣一氧化氮、肺通氣功能測試和乙酰甲膽堿支氣管激髮試驗。哮喘控製組，部分控製組，未控製組FeNO結果、BPT 對數轉換PC20(lnPC20)與正常對照組均有顯著差異，有統計學意義，P＜0.05。哮喘控製組，部分控製組，未控製組用力肺活量結果與正常對照組無顯著差異，無統計學意義，P＞0.05。直線相關分析結果顯示：控製組、部分控製組、未控製組FeNO和支氣管激髮試驗藥物激髮濃度lnPC20均有直線相關性，為負相關。（分彆為r=-0.971,P＜0.05；r=-0.948,P＜0.05； r=-0.969,P＜0.05）結論：1.評估哮喘控製狀態需綜閤評定，不能單純用呼齣氣一氧化氮結果來評定。2.呼齣氣一氧化氮與支氣管激髮試驗PC20呈負相關。呼齣氣一氧化氮反映的氣道炎癥與支氣管激髮試驗反映的氣道反應性呈正相關。3.在臨床診斷及療效評價方麵，呼齣氣一氧化氮可部分取代支氣管激髮試驗評價支氣管哮喘患者的氣道炎癥及氣道高反應性。
목적：탐토분석호출기일양화담(Fractional exhaled Nitric Oxide，FeNO)여을선갑담감(methacholine)지기관격발시험(bronchial provocation test，BPT)능부반응효천공제정도급이자적상관성분석，평고이자재지기관효천진단급료효평개방면적림상개치。방법：선취2012.1-2013.10신향시중심의원호흡내과문진지기관효천비급성발작기환자42례삼가본연구측시，병근거《전구효천방치창의》2009방안비급성발작기효천공제상태분급표준분위공제조16례，부분공제조14례，미공제조12례。설정상대조조18례。수선진행호출기일양화담측시，연후진행폐통기공능측시，최후진행을선갑담감지기관격발시험。응용FEV1（제1초종용력호기용적）하강20%시을선갑담감적약물격발농도（PC20）평개기도반응성。응용FeNO평개기도염증。관찰측시중간출현적불량반응。결과：삼가측시자공60인，측시중간유7례퇴출。최종유효천공제조15례，부분공제조13례，미공제조10례，정상대조조15례완성호출기일양화담、폐통기공능측시화을선갑담감지기관격발시험。효천공제조，부분공제조，미공제조FeNO결과、BPT 대수전환PC20(lnPC20)여정상대조조균유현저차이，유통계학의의，P＜0.05。효천공제조，부분공제조，미공제조용력폐활량결과여정상대조조무현저차이，무통계학의의，P＞0.05。직선상관분석결과현시：공제조、부분공제조、미공제조FeNO화지기관격발시험약물격발농도lnPC20균유직선상관성，위부상관。（분별위r=-0.971,P＜0.05；r=-0.948,P＜0.05； r=-0.969,P＜0.05）결론：1.평고효천공제상태수종합평정，불능단순용호출기일양화담결과래평정。2.호출기일양화담여지기관격발시험PC20정부상관。호출기일양화담반영적기도염증여지기관격발시험반영적기도반응성정정상관。3.재림상진단급료효평개방면，호출기일양화담가부분취대지기관격발시험평개지기관효천환자적기도염증급기도고반응성。
Objective To compare the value of fractional exhaled nitric oxide(FeNO) and methacholine bronchial provocation test(BPT) the degree of asthma control status. To investigate the correlation analysis between them and evaluate the clinical value in diagnosis and treatment of asthma.Methods:We selected 42 cases non-acute episode asthma join in the testing from Clinic of Respiratory Medicine in 2012.1-2013.10 Xinxiang city centre Hospital. Diagnostic criteria are in line with "Global Initiative for Asthma" (GINA 2009) and "Asthma Prevention Guideline" revised by the Chinese Medical Association, 2008.There is 18 cases in Normal group. Before the test, the selected candidates are asked to sign an informed consent. First we performed fractional exhaled nitric oxide test, then pulmonary function tests, and finaly Methacholine bronchial provocation test. The Methacholine provocative concentration PC20 when application FEV1 decreased by 20% evaluate airway reactivity. Fractional exhaled nitric oxide test evaluate the airway inflammation. Adverse reactions were observed among the test.Results There were a total of 60 people participated in the test. There were seven cases to exit the test. There were 53 cases completed the fractional exhaled nitric oxide and pulmonary function tests ,so as to methacholine bronchial provocation test, which divided into 15 cases of asthma control group, 13 cases of partial control group, 10 cases of uncontrol group, normal group of 15 cases. The result were significantly different in fractional exhaled nitric oxide and bronchial provocation test lnPC20 between Asthma and the normal group, statisticaly significant, P <0.05. The FVC showed no significant difference between Asthma and the normal group. no statistical significance,P> 0.05. Linear correlation analysis results display: the control group fractional exhaled nitric oxide and bronchial provocation test lnPC20 has linear correlation, negative correlation. (r = -0.971, P <0.05).The partial control group fractional exhaled nitric oxide and bronchial provocation test lnPC20 has linear correlation, negative correlation. (r = -0.948,P <0.05) .The uncontrol group fractional exhaled nitric oxide and bronchial provocation test lnPC20 has linear correlation, negative correlation. (r = -0.969,P <0.05)Conclusion:1. Fractional exhaled nitric oxide can not assessed asthma control status isolate .It requires a comprehensive ways.2. Fractional exhaled nitric oxide and bronchial provocation test PC20 was negative correlation with fractional exhaled nitric oxide.3. In the part of clinical diagnosis and treatment evaluation, the Fractional exhaled nitric oxide is an important method of measuring airway inflammation. Bronchial provocation test can be partialy replaced by Fractional exhaled nitric oxide in the evaluation of asthma airway inflammation and airway hyper responsiveness.