本文選題：呼出氣一氧化氮 + 慢性咳嗽�。� 參考：《鄭州大學》2017年碩士論文

【摘要】：背景與目的慢性咳嗽含義指的是患者咳嗽持續(xù)時間超過八周,而且X線檢查結果表明患者不存在肺疾病證據(jù)的咳嗽。近年慢性咳嗽常被誤診為慢性支氣管炎,患者長期服用抗生素和止咳藥治療效果不佳。慢性咳嗽已成為呼吸科門診及住院的主要原因及患者主要耗資之一,我們有必要加強對這類疾病的認識。能正確分析患者的病因,有助于醫(yī)生對癥下藥,提高治療效果。探討呼出氣一氧化氮(FeNO)對慢性咳嗽患者氣道高反應性的檢測價值,觀察激素治療前后FeNO濃度的變化,為指導治療和判斷預后提供依據(jù)。方法1.通過前瞻性研究方法選取2014年3月-2015年3月在鄭州大學第二附屬醫(yī)院及信陽市中心醫(yī)院治療的300例慢性咳嗽患者,全部研究對象先進行FeNO檢測,再給予支氣管激發(fā)試驗,以支氣管激發(fā)試驗結果為金標準確定患者是否存在氣道高反應性,然后與呼出氣一氧化氮測定值進行比較。2.對支氣管激發(fā)試驗陽性患者給予糖皮質激素吸入治療并進行隨訪,監(jiān)測其治療2周、治療3月、治療6月后FeNO濃度的變化,通過統(tǒng)計學方法進行比較分析。結果1.支氣管激發(fā)試驗結果表明192例(64.00%)患者呈現(xiàn)陰性,108例(36.00%)呈現(xiàn)陽性,分別將其作為陰性組、陽性組。陰性組FeNO值(14.24±4.87)ppb,陽性組FeNO值(49.85±31.87)ppb,兩組相比較差異有統(tǒng)計學意義(t=9.541,P=0.006)。2.判定氣道高反應性的FeNO最佳值是26.5ppb,對應的特異性以及靈敏度分別為88.74%、65.21%,陽性預測值為87.53%,陰性預測值為66.95%。3.108例支氣管激發(fā)試驗陽性患者在給予激素治療2周后測得的FeNO濃度較治療前明顯下降,兩組相比較差異有統(tǒng)計學意義(t=19.37,P0.001);激素治療組在治療第3個月、第6個月時期測得的FeNO濃度值基本趨于正常,與同時期陰性組相比較差異無統(tǒng)計學意義(t=2.373,P0.05;t=1.941,P0.05)。結論FeNO檢測應用于慢性咳嗽患者的氣道高反應性的檢測中,能準確判定患者氣道反應性程度,具有較高的特異性以及敏感性;FeNO水平有助于評估慢性咳嗽患者的激素治療效果,對疾病的診斷和預后有著重要的指導價值。
[Abstract]:Background and objective chronic cough means that the duration of coughing for patients exceeds eight weeks, and the results of X - ray examination show that the patient has no evidence of lung disease. In recent years, chronic cough is often misdiagnosed as chronic bronchitis, and the long-term use of antibiotics and antitussive drugs is not effective. Chronic coughing has become an outpatient and living in the Department of respiration. The main reason for the hospital and one of the main cost of the patients is that it is necessary to strengthen the understanding of this kind of disease. It is helpful for the correct analysis of the cause of the patient, the medical treatment of the doctor and the improvement of the therapeutic effect. The detection value of FeNO on the airway hyperresponsiveness of the patients with chronic cough and the changes of the concentration of FeNO before and after the hormone therapy are observed. In order to provide the basis for guiding the treatment and judging the prognosis. Method 1. through prospective study, 300 patients with chronic cough were selected in the Second Affiliated Hospital of Zhengzhou University and Xinyang Central Hospital in March -2015 in March 2014. All the subjects were tested first by FeNO, and then the bronchial provocation test was given to the bronchial provocation test knot. To determine whether the patients had airway hyperresponsiveness for the gold standard, and then compared with the exhaled nitric oxide (no) determination value,.2. was given the treatment of glucocorticoid inhalation for the positive patients with bronchial provocation test and followed up for 2 weeks. The treatment for March, the changes in the concentration of FeNO after June, were compared by statistical methods. Results the results of 1. bronchial provocation test showed that 192 cases (64%) were negative, 108 cases (36%) were positive, respectively, as negative group, positive group, negative group FeNO value (14.24 + 4.87) ppb, FeNO value of positive group (49.85 + 31.87) ppb, two groups were statistically significant (t=9.541, P=0.006).2. to determine the airway hyperresponsiveness FeN The optimal value of O was 26.5ppb, the corresponding specificity and sensitivity were 88.74%, 65.21%, positive predictive value 87.53%, negative predictive value for 66.95%.3.108 cases of bronchial provocation test positive patients after 2 weeks of hormone therapy was significantly lower than before the treatment (t=19.37, P0.001); the difference was statistically significant (t=19.37, P0.001); The value of FeNO concentration measured in the treatment group for third months and sixth months tended to be normal, and there was no significant difference between the same period negative group (t=2.373, P0.05; t=1.941, P0.05). Conclusion the application of FeNO to the detection of airway hyperresponsiveness in patients with chronic cough can accurately determine the degree of airway responsiveness of the patients. High specificity and sensitivity, FeNO level can help to evaluate the effect of hormone therapy in chronic cough patients and have important guidance value for the diagnosis and prognosis of the disease.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R56

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