中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
29期
3430-3434
,共5页
一氧化氮%支气管哮喘%诊断%ROC曲线
一氧化氮%支氣管哮喘%診斷%ROC麯線
일양화담%지기관효천%진단%ROC곡선
Nitric oxide%Bronchial asthma%Diagnosis%ROC curve
目的：评估呼出气一氧化氮（ FeNO）诊断支气管哮喘的准确性及其对支气管哮喘治疗效果的评估价值。方法连续入选2013年7月-2014年2月广州中山大学附属第一医院呼吸科门诊有咳嗽、气促、胸闷、喘息等临床表现疑似支气管哮喘的患者266例，借助FeNO分析仪进行检查，以传统肺功能检测（支气管激发试验或舒张试验）作为支气管哮喘诊断的金标准，绘制FeNO诊断支气管哮喘的ROC曲线，并确定其最佳截点。将第1秒用力呼气末容积（FEV1）下降20%的激发浓度（PC20）与FeNO进行相关性分析。对确诊支气管哮喘患者给予为期12周的布地奈德（200μg/次，2次/d）吸入治疗，检测治疗前后FeNO及肺功能变化，评估FeNO对支气管哮喘治疗效果的评估价值。结果266例疑似支气管哮喘患者中最终确诊127例，规范使用治疗药物者35例。支气管哮喘组FeNO水平高于非支气管哮喘组〔（65.66±33.68）μg/L和（29.49±20.56）μg/L，t=7.89，P<0.05〕；激发试验阳性患者FeNO与PC20呈负相关（r=-0.599，P<0.05）；FeNO诊断支气管哮喘的ROC曲线下面积为0.861，最佳截点为46.5μg/L；以FeNO为46.5μg/L诊断支气管哮喘的灵敏度为70.1%，特异度为93.9%，阳性预测值为93.2%，阴性预测值为72.7%。治疗12周后FeNO及第1秒用力呼气末容积占预计值百分比（ FEV1%）较治疗前改善〔（46.36±23.18）μg/L和（85.12±38.19）μg/L，t=9.45，P<0.05；（84.89±12.68）和（75.46±13.75），t=4.79，P<0.05〕。结论在支气管哮喘初筛或诊断中，FeNO具有较高的灵敏度和特异度，持续监测FeNO有助于支气管哮喘治疗效果的评估和管理。
目的：評估呼齣氣一氧化氮（ FeNO）診斷支氣管哮喘的準確性及其對支氣管哮喘治療效果的評估價值。方法連續入選2013年7月-2014年2月廣州中山大學附屬第一醫院呼吸科門診有咳嗽、氣促、胸悶、喘息等臨床錶現疑似支氣管哮喘的患者266例，藉助FeNO分析儀進行檢查，以傳統肺功能檢測（支氣管激髮試驗或舒張試驗）作為支氣管哮喘診斷的金標準，繪製FeNO診斷支氣管哮喘的ROC麯線，併確定其最佳截點。將第1秒用力呼氣末容積（FEV1）下降20%的激髮濃度（PC20）與FeNO進行相關性分析。對確診支氣管哮喘患者給予為期12週的佈地奈德（200μg/次，2次/d）吸入治療，檢測治療前後FeNO及肺功能變化，評估FeNO對支氣管哮喘治療效果的評估價值。結果266例疑似支氣管哮喘患者中最終確診127例，規範使用治療藥物者35例。支氣管哮喘組FeNO水平高于非支氣管哮喘組〔（65.66±33.68）μg/L和（29.49±20.56）μg/L，t=7.89，P<0.05〕；激髮試驗暘性患者FeNO與PC20呈負相關（r=-0.599，P<0.05）；FeNO診斷支氣管哮喘的ROC麯線下麵積為0.861，最佳截點為46.5μg/L；以FeNO為46.5μg/L診斷支氣管哮喘的靈敏度為70.1%，特異度為93.9%，暘性預測值為93.2%，陰性預測值為72.7%。治療12週後FeNO及第1秒用力呼氣末容積佔預計值百分比（ FEV1%）較治療前改善〔（46.36±23.18）μg/L和（85.12±38.19）μg/L，t=9.45，P<0.05；（84.89±12.68）和（75.46±13.75），t=4.79，P<0.05〕。結論在支氣管哮喘初篩或診斷中，FeNO具有較高的靈敏度和特異度，持續鑑測FeNO有助于支氣管哮喘治療效果的評估和管理。
목적：평고호출기일양화담（ FeNO）진단지기관효천적준학성급기대지기관효천치료효과적평고개치。방법련속입선2013년7월-2014년2월엄주중산대학부속제일의원호흡과문진유해수、기촉、흉민、천식등림상표현의사지기관효천적환자266례，차조FeNO분석의진행검사，이전통폐공능검측（지기관격발시험혹서장시험）작위지기관효천진단적금표준，회제FeNO진단지기관효천적ROC곡선，병학정기최가절점。장제1초용력호기말용적（FEV1）하강20%적격발농도（PC20）여FeNO진행상관성분석。대학진지기관효천환자급여위기12주적포지내덕（200μg/차，2차/d）흡입치료，검측치료전후FeNO급폐공능변화，평고FeNO대지기관효천치료효과적평고개치。결과266례의사지기관효천환자중최종학진127례，규범사용치료약물자35례。지기관효천조FeNO수평고우비지기관효천조〔（65.66±33.68）μg/L화（29.49±20.56）μg/L，t=7.89，P<0.05〕；격발시험양성환자FeNO여PC20정부상관（r=-0.599，P<0.05）；FeNO진단지기관효천적ROC곡선하면적위0.861，최가절점위46.5μg/L；이FeNO위46.5μg/L진단지기관효천적령민도위70.1%，특이도위93.9%，양성예측치위93.2%，음성예측치위72.7%。치료12주후FeNO급제1초용력호기말용적점예계치백분비（ FEV1%）교치료전개선〔（46.36±23.18）μg/L화（85.12±38.19）μg/L，t=9.45，P<0.05；（84.89±12.68）화（75.46±13.75），t=4.79，P<0.05〕。결론재지기관효천초사혹진단중，FeNO구유교고적령민도화특이도，지속감측FeNO유조우지기관효천치료효과적평고화관리。
Objective To evaluate the value of fractional exhaled nitric oxide( FeNO)in diagnosis of asthma and its therapeutic reactions. Methods From July 2013 to February 2014,in Respiratory Medicine of the First Affiliated Hospital of Sun Yet-sen University,266 suspected bronchial asthma( BA)patients underwent examinations with FeNO analyzer. Taking traditional pulmonary function testing as diagnostic gold standard,we drew ROC curve of FeNO diagnosing BA and determined its cut-off point. The correlation between PC20 stimulated by FEV1 decreasing by 20% and FeNO was analyzed. The diagnosed patients were given budesonide inhalation therapy,200 μg/time,twice/d,12 wk. The changes of FeNO and lung function be-fore and after treatment were detected and the role of FeNO in BA treatment evaluated. Results In 266 suspected BA patients, 127 were diagnosed at last,35 took medicine normatively. FeNO level was higher in BA group than in non-BA group〔(65. 66 ± 33. 68)μg/L vs. (29. 49 ± 20. 56)μg/L,t=7. 89,P<0. 05〕. FeNO was negatively correlated with PC20 in patients with positive provocative test(r= -0. 599,P<0. 05). The area under ROC curve of FeNO diagnosing BA was 0. 861,the best cut-off point was 46. 5 μg/L. The sensitivity of FeNO=46. 5 μg/L diagnosing BA was 70. 1%,specificity 93. 9%,posi-tive predictive value 93. 2%,negative predictive value 72. 7%. FeNO and FEV1% were better after treatment〔(46. 36 ± 23. 18)μg/L vs. (85. 12 ± 38. 19)μg/L,t=9. 45,P<0. 05;(84. 89 ± 12. 68)vs. (75. 46 ± 13. 75),t=4. 79,P<0. 05〕. Conclusion In BA screening and diagnosis,FeNO is of high sensitivity and specificity. Continuous FeNO monitoring contributes to BA's evaluation of treatment and management.
