中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
31期
17-19
,共3页
蒋雄斌%黄茂%殷凯生%朱毅
蔣雄斌%黃茂%慇凱生%硃毅
장웅빈%황무%은개생%주의
哮喘%一氧化氮%诊断%支气管舒张试验%受试者工作特征曲线
哮喘%一氧化氮%診斷%支氣管舒張試驗%受試者工作特徵麯線
효천%일양화담%진단%지기관서장시험%수시자공작특정곡선
Asthma%Nitric oxide%Diagnosis%Bronchial bronchodilator test%Receiver operating characteristic curves
目的 评价呼出气一氧化氮(FeNO)检测在非典型支气管哮喘诊断中的应用价值.方法 纳入有喘息、咳嗽、胸闷等疑似支气管哮喘患者95例.使用一氧化氮(N0)测定仪检测FeNO水平,检测过程严格按照美国胸科协会制定的指南进行.以临床表现和支气管舒张试验为支气管哮喘诊断的金标准,绘制受试者工作特征(ROC)曲线,结合ROC曲线明确FeNO的诊断临界点,以评价FeNO检测对非典型支气管哮喘的诊断价值.结果 95例患者中,临床诊断为支气管哮喘44例,非支气管哮喘51例.支气管哮喘患者FeNO水平为(55.2±14.0)nmol/L),明显高于非支气管哮喘患者的(18.9±5.2)nmol/L,差异有统计学意义(P＜0.01).支气管哮喘患者FeNO水平与第1秒用力呼气容积占预计值百分比无直线相关性(r=-0.162,P＞0.05).ROC曲线下面积为0.858,最佳临界点为36 nmol/L,以该点为阈值,诊断支气管哮喘的敏感度为80.2％,特异度为79.5％,阳性预测值为85.4％,阴性预测值为83.3％,准确度为85.9％.结论 FeNO检测对非典型支气管哮喘的诊断具有较高的敏感度和特异度,如结合肺功能检查可提高诊断效率,防止漏诊及误诊.
目的 評價呼齣氣一氧化氮(FeNO)檢測在非典型支氣管哮喘診斷中的應用價值.方法 納入有喘息、咳嗽、胸悶等疑似支氣管哮喘患者95例.使用一氧化氮(N0)測定儀檢測FeNO水平,檢測過程嚴格按照美國胸科協會製定的指南進行.以臨床錶現和支氣管舒張試驗為支氣管哮喘診斷的金標準,繪製受試者工作特徵(ROC)麯線,結閤ROC麯線明確FeNO的診斷臨界點,以評價FeNO檢測對非典型支氣管哮喘的診斷價值.結果 95例患者中,臨床診斷為支氣管哮喘44例,非支氣管哮喘51例.支氣管哮喘患者FeNO水平為(55.2±14.0)nmol/L),明顯高于非支氣管哮喘患者的(18.9±5.2)nmol/L,差異有統計學意義(P＜0.01).支氣管哮喘患者FeNO水平與第1秒用力呼氣容積佔預計值百分比無直線相關性(r=-0.162,P＞0.05).ROC麯線下麵積為0.858,最佳臨界點為36 nmol/L,以該點為閾值,診斷支氣管哮喘的敏感度為80.2％,特異度為79.5％,暘性預測值為85.4％,陰性預測值為83.3％,準確度為85.9％.結論 FeNO檢測對非典型支氣管哮喘的診斷具有較高的敏感度和特異度,如結閤肺功能檢查可提高診斷效率,防止漏診及誤診.
목적 평개호출기일양화담(FeNO)검측재비전형지기관효천진단중적응용개치.방법 납입유천식、해수、흉민등의사지기관효천환자95례.사용일양화담(N0)측정의검측FeNO수평,검측과정엄격안조미국흉과협회제정적지남진행.이림상표현화지기관서장시험위지기관효천진단적금표준,회제수시자공작특정(ROC)곡선,결합ROC곡선명학FeNO적진단림계점,이평개FeNO검측대비전형지기관효천적진단개치.결과 95례환자중,림상진단위지기관효천44례,비지기관효천51례.지기관효천환자FeNO수평위(55.2±14.0)nmol/L),명현고우비지기관효천환자적(18.9±5.2)nmol/L,차이유통계학의의(P＜0.01).지기관효천환자FeNO수평여제1초용력호기용적점예계치백분비무직선상관성(r=-0.162,P＞0.05).ROC곡선하면적위0.858,최가림계점위36 nmol/L,이해점위역치,진단지기관효천적민감도위80.2％,특이도위79.5％,양성예측치위85.4％,음성예측치위83.3％,준학도위85.9％.결론 FeNO검측대비전형지기관효천적진단구유교고적민감도화특이도,여결합폐공능검사가제고진단효솔,방지루진급오진.
Objective To study the diagnostic value of fractional exhaled nitric oxide(FeNO)in non-typical bronchial asthma.Methods Ninety-five patients with unknown-cause respiratory symptoms including wheezing,cough and breathlessness were enrolled.FeNO was measured by nitric oxide analyzer.The clinical symptoms and bronchial bronchodilator test were defined as golden standard for asthma diagnosis.The diagnostic value of FeNO was assessed and the optimal operating point of FeNO test was determined by means of the receiver operating characteristic(ROC)curve.Results Among 95 patients,44 cases were diagnosed as asthma,51 cases were diagnosed as non-asthma.The level of FeNO of asthma patients were higher than that of non-asthma patients[(55.2±14.0)nmol/L vs.(18.9±5.2)nmol/L,P＜0.01].A non-linear correlation of FeNO with FEV1％ was revealed in the cases with asthma(r=-0.162,P＞0.05).Area under ROC curve was 0.858.The optimal diagnostic cut off point was 36 nmol/L which was capable of differentiating asthma and non-asthma with sensitivity of 80.2％,specificity of 79.5％,positive predictive value of 85.4％,negative predictive value of 83.3％ and accuracy of 85.9％.Conclusions FeNO test may be helpful in the diagnosis of non-typical asthma with high sensitivity and specificity,which can also improve the diagnostic effectiveness and avoid misdiagnosis,missed diagnosis when combined with lung function test.
