中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2015年
6期
634-638
,共5页
呼出气一氧化氮%哮喘-COPD重叠综合征%慢性阻塞性肺疾病%哮喘%老年%肺功能%诊断%治疗
呼齣氣一氧化氮%哮喘-COPD重疊綜閤徵%慢性阻塞性肺疾病%哮喘%老年%肺功能%診斷%治療
호출기일양화담%효천-COPD중첩종합정%만성조새성폐질병%효천%노년%폐공능%진단%치료
Fractional exhaled nitric oxide%Asthma-COPD overlap syndrome%Chronic obstructive pulmonary disease%Asthma%Elderly%Pulmonary function test%Diagnosis%Treatment
目的 探讨呼出气一氧化氮(FeNO)检测对哮喘-COPD重叠综合征(ACOS)的诊疗意义.方法 连续收集2013年9月至2014年6月在暨南大学第二临床医学院就诊的老年ACOS、哮喘、COPD及慢性咳嗽患者共195例,对所有患者均进行胸部影像学、FeNO、肺通气功能及支气管舒张功能检测,分析四组患者间FeNO、FEV1/pred％、FEV1/FVC的差异,以及各组内FeNO与FEV1/pred％、FEV1/FVC的相关性.结果 ACOS组和哮喘组患者的FeNO值均显著高于COPD组及对照组[(30.9±27.8),(34.5 ±29.4) vs.(17.3±9.9,16.1±8.6),P均＜0.05],ACOS组和COPD组的肺通气功能则显著低于哮喘组及对照组[FEV1/pred％,(52.9±8.4,53.5±9.6)vs.(81.1±5.9,85.7±7.1),P均＜0.05; FEV1/FVC,(51.9±7.2,50.7±7.1)vs.(79.2±4.8,81.0±5.9),P＜0.05];除对照组中FeNO与FEV1/pred％呈正相关外,其余各组内FeNO值与FEV1/pred％及FEV1/FVC值之间均无显著相关性[ACOS组,r=0.115,-0.007 (P =0.464,0.963);哮喘组,r=0.038,0.045(P=0.772,0.733);COpD组,r=0.097,0.010 (P =0.498,0.944);对照组,r=0.315,0.091 (P=0.045,0.571)].结论 FeNO与肺通气功能联合应用有助于ACOS与其他慢性阻塞性气道疾病的鉴别诊断;对于FeNO显著升高的老年COPD患者应注意有无ACOS可能,治疗上可使用吸人性糖皮质激素以降低气道炎症.
目的 探討呼齣氣一氧化氮(FeNO)檢測對哮喘-COPD重疊綜閤徵(ACOS)的診療意義.方法 連續收集2013年9月至2014年6月在暨南大學第二臨床醫學院就診的老年ACOS、哮喘、COPD及慢性咳嗽患者共195例,對所有患者均進行胸部影像學、FeNO、肺通氣功能及支氣管舒張功能檢測,分析四組患者間FeNO、FEV1/pred％、FEV1/FVC的差異,以及各組內FeNO與FEV1/pred％、FEV1/FVC的相關性.結果 ACOS組和哮喘組患者的FeNO值均顯著高于COPD組及對照組[(30.9±27.8),(34.5 ±29.4) vs.(17.3±9.9,16.1±8.6),P均＜0.05],ACOS組和COPD組的肺通氣功能則顯著低于哮喘組及對照組[FEV1/pred％,(52.9±8.4,53.5±9.6)vs.(81.1±5.9,85.7±7.1),P均＜0.05; FEV1/FVC,(51.9±7.2,50.7±7.1)vs.(79.2±4.8,81.0±5.9),P＜0.05];除對照組中FeNO與FEV1/pred％呈正相關外,其餘各組內FeNO值與FEV1/pred％及FEV1/FVC值之間均無顯著相關性[ACOS組,r=0.115,-0.007 (P =0.464,0.963);哮喘組,r=0.038,0.045(P=0.772,0.733);COpD組,r=0.097,0.010 (P =0.498,0.944);對照組,r=0.315,0.091 (P=0.045,0.571)].結論 FeNO與肺通氣功能聯閤應用有助于ACOS與其他慢性阻塞性氣道疾病的鑒彆診斷;對于FeNO顯著升高的老年COPD患者應註意有無ACOS可能,治療上可使用吸人性糖皮質激素以降低氣道炎癥.
목적 탐토호출기일양화담(FeNO)검측대효천-COPD중첩종합정(ACOS)적진료의의.방법 련속수집2013년9월지2014년6월재기남대학제이림상의학원취진적노년ACOS、효천、COPD급만성해수환자공195례,대소유환자균진행흉부영상학、FeNO、폐통기공능급지기관서장공능검측,분석사조환자간FeNO、FEV1/pred％、FEV1/FVC적차이,이급각조내FeNO여FEV1/pred％、FEV1/FVC적상관성.결과 ACOS조화효천조환자적FeNO치균현저고우COPD조급대조조[(30.9±27.8),(34.5 ±29.4) vs.(17.3±9.9,16.1±8.6),P균＜0.05],ACOS조화COPD조적폐통기공능칙현저저우효천조급대조조[FEV1/pred％,(52.9±8.4,53.5±9.6)vs.(81.1±5.9,85.7±7.1),P균＜0.05; FEV1/FVC,(51.9±7.2,50.7±7.1)vs.(79.2±4.8,81.0±5.9),P＜0.05];제대조조중FeNO여FEV1/pred％정정상관외,기여각조내FeNO치여FEV1/pred％급FEV1/FVC치지간균무현저상관성[ACOS조,r=0.115,-0.007 (P =0.464,0.963);효천조,r=0.038,0.045(P=0.772,0.733);COpD조,r=0.097,0.010 (P =0.498,0.944);대조조,r=0.315,0.091 (P=0.045,0.571)].결론 FeNO여폐통기공능연합응용유조우ACOS여기타만성조새성기도질병적감별진단;대우FeNO현저승고적노년COPD환자응주의유무ACOS가능,치료상가사용흡인성당피질격소이강저기도염증.
Objective To explore the value of fractional exhaled nitric oxide (FeNO) in diagnosis and treatment of asthma-COPD overlap syndrome (ACOS).Methods A total of 195 patients categorized into elderly ACOS,asthma,COPD and chronic cough groups were consecutively admitted from September 2013 to June 2014 in our hospital.All patients were examined with chest imaging,fractional exhaled nitric oxide (FeNO) test,and pulmonary function tests to analyze the differences in FeNO,FEV1/pred％ and FEV1/FVC among four groups,and to detect the relevance of FeNO to FEV1/pred％ and FEV1/FVC within each group.Results Both of the ACOS and asthma groups had higher FeNO values than the COPD and control groups [(30.9 ± 27.8,34.5 ± 29.4) vs.(17.3 ± 9.9,16.1 ± 8.6),P ＜ 0.05],while the values of FEV1/pred％ and FEV1/FVC in the ACOS and COPD groups were significantly lower than those in the other twogroups [FEV1/pred％,(52.9±8.4,53.5 ±9.6) vs.(81.1 ±5.9,85.7 ±7.1),allP＜0.05; FEV1/FVC,(51.9 ± 7.2,50.7 ± 7.1) vs.(79.2 ± 4.8,81.0 ± 5.9),all P ＜ 0.05].Although FeNO was directly related to FEV1/pred％ in the control group,there were no significant correlation between FeNO and FEV1/pred％ (or FEV1/FVC) in the other three groups [ACOS group,r =0.115,-0.007 (P =0.464,0.963) ; asthma group,r =0.038,0.045 (P =0.772,0.733) ; COPD group,r =0.097,0.010(P=0.498,0.944); control group,r =0.315,0.091 (P =0.045,0.571)].Conclusions The combination of FeNO and pulmonary function tests can facilitate the differential diagnosis of ACOS and other chronic obstructive airways disorders.For the elderly COPD patients with higher FeNO values,it should be noted whether they were complicated by ACOS or not.Furthermore,the inhalation of corticosteroid can be used to reduce the airway inflammation in these patients.
