【摘要】：背景支氣管哮喘(簡稱哮喘)是一種呼吸道慢性炎癥性疾病,臨床表現(xiàn)為氣道高反應(yīng)性及氣流可逆性。目前,臨床上多根據(jù)肺功能、臨床癥狀來診斷、監(jiān)測哮喘和指導(dǎo)用藥,其存在一定局限性(不能真實反映呼吸道炎癥,不是每次肺功能測定均顯示呼吸道的可逆性,特別是正在接受治療的哮喘患者),遠(yuǎn)遠(yuǎn)滿足不了臨床需要。呼出氣一氧化氮(fractional exhaled nitric oxide,FeNO)是近年來新發(fā)現(xiàn)的反應(yīng)呼吸道炎癥的指標(biāo),有研究證實其可反應(yīng)呼吸道嗜酸性粒細(xì)胞(eosinophils,EOS)炎癥水平,且因其是一種無創(chuàng)性、操作簡便、重復(fù)性好的檢查而用于臨床。FeNO不僅可以反應(yīng)氣道炎癥,也能反應(yīng)吸入糖皮質(zhì)激素(inhaled corticosteroids,ICS)治療的敏感性。部分學(xué)者認(rèn)為FeNO水平可用來診斷哮喘及指導(dǎo)哮喘用藥,但其目前對嗜酸性粒細(xì)胞表型哮喘診斷價值及ICS治療療效尚未達(dá)成共識。目的探討FeNO檢測對嗜酸性粒細(xì)胞表型哮喘的臨床診斷價值及ICS療效評價的意義。方法對2015年4月至2016年2月在新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院呼吸內(nèi)科住院的支氣管哮喘患者,入選患者均為急性發(fā)作期,為哮喘組(62例),哮喘組患者根據(jù)誘導(dǎo)痰細(xì)胞檢查分為嗜酸性粒細(xì)胞組(31例)和非嗜酸性粒細(xì)胞組(31例),其中嗜酸性粒細(xì)胞組按疾病嚴(yán)重程度又分為輕度哮喘組(7例)、中度哮喘組(13例)和重度哮喘組(11例);每組患者給予多索茶堿0.2g靜脈輸液,每天2次;西替利嗪10mg,每晚1次口服;孟魯斯特10mg,每晚1次口服;霧化吸入布地奈德2mg和復(fù)方異丙托溴銨2.5ml霧化溶液,每天2次。常規(guī)治療7天。出院后所有患者吸入布地奈德吸入劑4周治療(200ug,每12小時1次)。治療前分別檢測患者的肺功能、哮喘控制測試(asthma control test,ACT)評分、FeNO水平及誘導(dǎo)痰嗜酸性粒細(xì)胞比例;治療后檢測患者的FeNO水平、ACT評分及肺功能。并且同時選取62例健康受試者為對照組,檢測FeNO水平。結(jié)果治療前,健康對照組FeNO水平明顯低于哮喘組,差異有統(tǒng)計學(xué)意義(t=7.414,P=0.000);非嗜酸性粒細(xì)胞組FeNO水平明顯低于嗜酸性粒細(xì)胞組,差異有統(tǒng)計學(xué)意義(t=6.568,P=0.000)。治療前,哮喘組FeNO和誘導(dǎo)痰嗜酸性粒細(xì)胞比例呈正相關(guān)(γ=0.823,P=0.000);其中,嗜酸性粒細(xì)胞組FeNO和誘導(dǎo)痰嗜酸性粒細(xì)胞比例呈正相關(guān)(γ=0.770,P=0.000),非嗜酸性粒細(xì)胞組FeNO和誘導(dǎo)痰嗜酸性粒細(xì)胞比例無相關(guān)性(γ=0.300,P=0.101)。治療前后FeNO水平比較,嗜酸性粒細(xì)胞組FeNO下降明顯,差異有統(tǒng)計學(xué)意義(t=7.440,P=0.000),非嗜酸性粒細(xì)胞組下降不明顯,差異無統(tǒng)計學(xué)意義(t=2.013,P=0.083);在嗜酸性粒細(xì)胞組中,輕、中、重度哮喘組治療后FeNO水平低于治療前,差異均有統(tǒng)計學(xué)意義(t=3.535,P=0.012;t=8.171,P=0.000;t=7.161,P=0.000)。治療后根據(jù)ACT評分判斷癥狀控制情況,嗜酸性粒細(xì)胞組控制率(67.7%)與非嗜酸性粒細(xì)胞組控制率(22.6%)比較差異有統(tǒng)計學(xué)意義(χ2=12.765,P=0.000);在嗜酸性粒細(xì)胞哮喘組中,輕度哮喘組控制率(28.6%)與中(76.9%)、重度哮喘組控制率(81.8%)比較差異有統(tǒng)計學(xué)意義(χ2=6.418,P=0.011;χ2=7.103,P=0.008),中度哮喘組與重度哮喘組控制率比較差異無統(tǒng)計學(xué)意義(χ2=0.087,P=0.769)。結(jié)論FeNO水平能反映嗜酸性粒細(xì)胞哮喘患者氣道炎癥程度,可用于嗜酸性粒細(xì)胞表型哮喘的診斷,對嗜酸性粒細(xì)胞哮喘患者ICS療效評價有一定臨床價值。
[Abstract]:Background Bronchial asthma (asthma) is a chronic inflammatory disease of the respiratory tract. Its clinical manifestations are airway hyperresponsiveness and airflow reversibility. Respiratory tract reversibility, especially in asthmatic patients undergoing treatment, is far from meeting clinical needs. Exhaled nitric oxide (FeNO) is a newly discovered indicator of respiratory inflammation in recent years, and has been confirmed to be responsive to eosinophils (EOS) inflammation. FeNO can not only reflect airway inflammation, but also reflect the sensitivity of inhaled corticosteroids (ICS). Some scholars believe that FeNO level can be used to diagnose asthma and guide asthma medication, but it is currently used for eosinophils. Objective To investigate the clinical value of FeNO detection in the diagnosis of eosinophilic asthma and the evaluation of ICS efficacy. Methods From April 2015 to February 2016, all the patients with bronchial asthma in the Department of Respiratory Medicine, First Affiliated Hospital of Xinxiang Medical College were enrolled. Asthma patients were divided into eosinophil group (31 cases) and non-eosinophil group (31 cases) according to the induced sputum test. The eosinophil group was divided into mild asthma group (7 cases), moderate asthma group (13 cases) and severe asthma group (11 cases) according to the severity of the disease. Sotheophylline 0.2g intravenous infusion, twice a day; cetirizine 10mg, once a night; montelukast 10mg, once a night; nebulized budesonide 2mg and compound ipratropium bromide 2.5ml aerosol solution, twice a day. Routine treatment lasted for 7 days. All patients were treated with budesonide inhalation for 4 weeks (200ug, once every 12 hours) after discharge. The pulmonary function, asthma control test (ACT), the level of FeNO and the proportion of eosinophils in induced sputum were measured. The levels of FeNO, ACT and pulmonary function were measured after treatment. 62 healthy subjects were selected as control group to detect the level of FeNO. In asthma group, the difference was statistically significant (t = 7.414, P = 0.000); the level of FeNO in non-eosinophil group was significantly lower than that in eosinophil group, the difference was statistically significant (t = 6.568, P = 0.000). Before treatment, the proportion of FeNO in asthma group was positively correlated with the proportion of eosinophils in induced sputum (gamma = 0.823, P = 0.000); among them, the level of FeNO in eosinophil group was significantly lower than that in induced sputum (t = 6.568, P The ratio of eosinophils was positively correlated (gamma = 0.770, P = 0.000). There was no correlation between the ratio of FeNO and eosinophils in induced sputum (gamma = 0.300, P = 0.101). The level of FeNO in eosinophils decreased significantly (t = 7.440, P = 0.000), but not in non-eosinophils. There was no significant difference (t = 2.013, P = 0.083); in the eosinophil group, the level of FeNO in the mild, moderate and severe asthma group after treatment was lower than that before treatment, the difference was statistically significant (t = 3.535, P = 0.012; t = 8.171, P = 0.000; t = 7.161, P = 0.000). The control rate of eosinophil group (22.6%) was significantly different (2 = 12.765, P = 0.000); the control rate of mild asthma group (28.6%) and moderate asthma group (76.9%) and severe asthma group (81.8%) were significantly different (2 = 6.418, P = 0.011; 2 = 7.103, P = 0.008), moderate asthma group and severe asthma group (2 = 6.418, P = 0.008). There was no significant difference in control rate (_2 = 0.087, P = 0.769). Conclusion FeNO level can reflect the degree of airway inflammation in patients with eosinophilic asthma, and can be used for the diagnosis of eosinophilic phenotypic asthma. It has certain clinical value in evaluating the efficacy of ICS in patients with eosinophilic asthma.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R562.25

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