本文選題：呼出氣一氧化氮　切入點：哮喘　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評價呼出氣一氧化氮(Fractional exhaled Nitric Oxide,FeNO)檢測在支氣管哮喘診斷與治療中的意義及其與支氣管哮喘患者嗜酸性粒細胞計數(shù)的相關(guān)性。方法:1.收集2016年1月至2016年12月期間就診新疆醫(yī)科大學(xué)第一附屬醫(yī)院呼吸科門診或呼吸科住院的有咳嗽、呼吸困難、胸悶氣憋等臨床癥狀的漢族患者共87例,行支氣管激發(fā)/舒張試驗和FeNO檢測及血常規(guī)檢查,依照指南診斷標準,診斷支氣管哮喘組62例,非哮喘組25例(最終確診慢性支氣管炎、支氣管擴張等),比較兩組外周血嗜酸性粒細胞計數(shù)、Fe NO水平的差異,評價外周血嗜酸性粒細胞計數(shù)與FeNO水平的相關(guān)性,繪制ROC曲線,評價FeNO對支氣管哮喘的診斷價值。支氣管哮喘組依據(jù)外周血嗜酸性粒細胞計數(shù)分為高嗜酸組和低嗜酸組,比較兩組FeNO水平的差異。2.哮喘組患者正規(guī)治療3月后比較外周血嗜酸性粒細胞計數(shù)、FeNO水平與治療前的變化,評估FeNO在評價支氣管哮喘療效中的價值。結(jié)果:哮喘組與非哮喘組FeNO值(42.66±16.13ppb比20.88±8.96ppb)差異有統(tǒng)計學(xué)意義(P0.05),外周血嗜酸性粒細胞計數(shù)(0.64±0.37比0.29±0.18)差異有統(tǒng)計學(xué)意義;支氣管哮喘組外周血嗜酸性粒細胞計數(shù)與FeNO水平正相關(guān),(r=0.62,P0.05,有統(tǒng)計學(xué)意義);以支氣管舒張或激發(fā)試驗為診斷支氣管哮喘的“金標準”,評估FeNO對支氣管哮喘的診斷價值,ROC曲線下面積為0.885,95%置信區(qū)間為(0.816,0.955),繪制ROC曲線,最佳閾值為28.5ppb。將FeNO28.5 ppb定義為支氣管哮喘的診斷標準,敏感度為80.6%,特異度為84%;哮喘組患者3月后共有50名患者完成隨訪,治療前后FENO值42.66±16.13ppb比20.84±5.69ppb,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:哮喘患者FeNO水平高于非哮喘患者;哮喘患者FeNO水平與外周血嗜酸性粒細胞正相關(guān);FeNO對支氣管哮喘有較好的特異度;FeNO水平能較好的評價哮喘的治療效果。
[Abstract]:Objective: to evaluate the significance of exhaled Nitric Feno in the diagnosis and treatment of bronchial asthma and its correlation with eosinophil count in asthmatic patients. Methods: 1. From January 2016 to December 2016, we collected the eosinophil count in bronchial asthma patients. During the visit to the Department of Respiratory Department of the first affiliated Hospital of Xinjiang Medical University, there was a cough in the outpatient department or in the respiratory department. A total of 87 Han patients with clinical symptoms such as dyspnea, chest tightness, and so on were treated with bronchial provocation / relaxation test, FeNO test and blood routine examination. 62 cases of bronchial asthma group were diagnosed according to the diagnostic criteria. In 25 cases of non-asthmatic group (chronic bronchitis, bronchiectasis, etc.), the difference of eosinophil count and Fe no in peripheral blood was compared between the two groups, the correlation between eosinophil count and FeNO level in peripheral blood was evaluated, and the ROC curve was plotted. To evaluate the value of FeNO in the diagnosis of bronchial asthma. According to peripheral blood eosinophil count, bronchial asthma group was divided into hypereosinophilic group and low eosinophilic group. Comparison of FeNO levels between the two groups. 2. The changes of eosinophil count and Feno levels in peripheral blood after regular treatment in asthma group after March were compared with those before treatment. Results: the FeNO value of asthma group and non-asthma group was 42.66 鹵16.13 ppb vs 20.88 鹵8.96 ppb (P 0.05), and the eosinophil count in peripheral blood was 0.64 鹵0.37 vs 0.29 鹵0.18). The eosinophilic granulocyte count in peripheral blood of bronchial asthma group was positively correlated with the level of FeNO, P 0.05.The diagnostic value of FeNO for bronchial asthma was evaluated by bronchodiastolic or provocation test as the "gold standard" for the diagnosis of bronchial asthma. The area under the ROC curve is 0.885% and the confidence interval is 0.955%. The ROC curve is drawn. The optimal threshold was 28.5ppb. the FeNO28.5 ppb was defined as the diagnostic criteria for bronchial asthma, with a sensitivity of 80.6 and a specificity of 840.A total of 50 patients in the asthma group were followed up after March. The FENO value before and after treatment was 42.66 鹵16.13 ppb vs 20.84 鹵5.69 ppb, the difference was statistically significant (P 0.05). Conclusion: the level of FeNO in asthmatic patients is higher than that in non-asthmatic patients. The positive correlation between the level of FeNO and eosinophil in the peripheral blood of asthmatic patients showed that FeNO had a better specificity for asthma and could evaluate the therapeutic effect of asthma.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

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