应用呼出气一氧化氮联合脉冲振荡肺功能评估哮喘患者的小气道功能

doi:10.6040/j.issn.1671-7554.0.2015.1038

摘要/Abstract

摘要： 目的探讨呼出气一氧化氮(FeNO)及脉冲振荡肺功能(IOS)与哮喘患者小气道功能的关系。方法选取2014年7月至2015年7月于山东大学齐鲁医院呼吸科门诊就诊的哮喘患者140例,其中小气道功能正常组69例,小气道功能异常组71例,分别测定FeNO值、外周血嗜酸性粒细胞(EOS)及总免疫球蛋白E(IgE)、肺功能及IOS。结果小气道功能异常组FeNO、IgE、阻抗面积(AX)、共振频率(Fres)及 EOS水平明显高于小气道功能正常组,差异有统计学意义(P均<0.01);小气道功能异常组FeNO、AX、Fres及EOS水平与最大呼气中期流量占百分比预计值(FEF25%-75%pred)呈负相关(r=-0.856, P<0.001; r=-0.851, P<0.001; r=-0.398, P=0.001; r=-0.288, P=0.014);标准回归系数绝对值的比较:FeNO>AX>Fres>EOS;不同指标诊断哮喘小气道功能异常的预测价值:FeNO联合AX及 Fres>FeNO>AX>Fres>EOS。结论 FeNO水平和IOS指标是诊断哮喘小气道功能异常的敏感特异性指标;二者联合能更好地评估哮喘患者的小气道功能。

关键词: 支气管哮喘, 小气道功能异常, 呼出气一氧化氮, 脉冲振荡肺功能

Abstract: Objective To investigate the relationship between exhaled nitric oxide(FeNO)/impulse oscillometry(IOS)and small airway function in asthmatic patients. Methods A total of 140 asthma patients were divided into small airway normal function group(n=69)and small airway dysfunction group(n=71). FeNO, eosinophil(EOS)count and total immunoglobulin E(IgE)in peripheral blood and pulmonary function, as well as IOS were measured. Results The levels of FeNO, IgE, reactance area(AX), resonant frequency(Fres)and EOS in small airway dysfunction group were significantly higher than those in small airway normal function group(all P<0.01). FeNO, AX, Fres and EOS were correlative factors of mid forced expiratory flow of percentages of predicted values(FEF25%-75%pred)(r=-0.856, P<0.001; r=-0.851, P<0.001; r=-0.398, P=0.001; r=-0.288, P=0.014)and the turns of standard errors of partial regression coefficient were as follows: FeNO>AX>Fres>EOS. The turns of predictive value in diagnosis of small airway dysfunction were as follows: FeNO combining AX and Fres>FeNO>AX>Fres>EOS. Conclusion FeNO and IOS may be highly sensitive and specific in diagnosis of small airway dysfunction, and their combination can better evaluate the function of small airway in asthmatic patients.

Key words: Small airway dysfunction, Asthma, Fractional exhaled nitric oxide, Impulse oscillometry

中图分类号:

R562.2

刘琳,刘春红,王得翔,吴金香,赵继萍,刘甜,张元元,王俊飞,柳亚慧,曹柳兆,董亮. 应用呼出气一氧化氮联合脉冲振荡肺功能评估哮喘患者的小气道功能[J]. 山东大学学报（医学版）, 2016, 54(8): 78-83.

LIU Lin, LIU Chunhong, WANG Dexiang, WU Jinxiang, ZHAO Jiping, LIU Tian, ZHANG Yuanyuan, WANG Junfei, LIU Yahui, CAO Liuzhao, DONG Liang. Estimation on small airway function in asthmatic patients with fractional exhaled nitric oxide and impulse oscillometry[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(8): 78-83.

参考文献

[1] Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2015[EB/OL]. http:// www. ginaasthma.org, 2015-04-15/2015-07-02.
[2] Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2014[EB/OL]. http:// www.ginaasthma.org, 2014-05-06/2015-07-01.
[3] Hamid Q. Pathogenesis ofsmall airways inasthma[J]. Respiration, 2012, 84(1): 4-11.
[4] Tepper RS, Wise RS, Covar R, et al. Asthma outcomes: pulmonary physiology[J]. Allergy Clin Immunol, 2012, 129(Suppl 3): 65-87.
[5] Wagner EM, Liu MC, Weinmann GG, et al. Peripheral lung resistance in normal and asthmatic subjects[J]. Am Rev Respir Dis, 1990, 141(3): 584-588.
[6] Wagner EM, Bleecker ER, Permutt S, et al. Direct assessment of small airways reactivity in human subjects[J]. Am J Respir Crit Care Med, 1998, 157(2): 447-452.
[7] van der Velden J, Barker D, Barcham G, et al. Assessment of peripheral airway function following chronic allergen challenge in a sheep model of asthma[J]. PLoS One, 2011, 6:e28740. doi: 10.1371/journal.pone.0028740.
[8] van den Berge M, ten Hacken NH, Cohen J, et al. Small airway disease in asthma and COPD: clinical implications[J]. Chest, 2011, 139(2): 412-423.
[9] Omar S. Small airways dysfunction in asthma: evaluation and management to improve asthma control[J]. Allergy Asthma Immunol Res, 2014, 6(5): 376-388.
[10] Leach CL, Davidson PJ, Hasselquist BE. Lung deposition of hydrofluoroalkane-134a beclomethasone is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone: a cross-over study in healthy volunteers[J]. Chest, 2002, 122(2): 510-516.
[11] Marseglia GL, Cirillo I, Vizzaccaro A, et al. Role of forced expiratory flow at 25%-75% as an early marker of small airways impairment in subjects with allergic rhinitis[J]. Allergy Asthma Proc, 2007, 28(1): 74-78.
[12] Cirillo I, Klersy C, Marseglia GL, et al. Role of FEF25%-75% as a predictor of bronchial hyperreactivity in allergic patients[J]. Ann Allergy Asthma Immunol, 2006, 96(5): 692-700.
[13] Nielsen KG, Bisgaard H. The effect of inhaled budesonide on symptoms, lung function, and cold air and methacholine responsiveness in 2-to-5-year-old asthmatic children[J]. Am J Respir Crit Care Med, 2000, 162(4 Pt 1): 1500-1506.
[14] Biermer L. The role of small airway disease in asthma[J]. Curr Opin Pulm Med, 2014, 20(1): 23-30.
[15] Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: inerpretation of exhaled nitric oxide leves(FENO)for clinical application[J]. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
[16] Bjermer L. History and future perspectives of treating asthma as a systemic and small airways disease[J]. Respir Med, 2001, 95(9): 703-719.
[17] van der Wiel E, Postma DS, van der Molen T, et al. Effects of small airway dysfunction on the clinical expression of asthma: a focus on asthma symptoms and bronchial hyper-responsiveness[J]. Allergy, 2014, 69(12): 1681-1688.
[18] Shi Y, Aledia AS, Tatavoosian AV, et al. Relating small airways to asthma control by using impulse oscillometry in children[J]. Allergy Clin Immunol, 2012, 129(3): 671-678.
[19] Lie MK, Christodoulopoulos P, Hamid Q. Small airway inflammation in asthma[J]. Respir Res, 2001, 2(6): 333-339.
[20] van der Wiel E, ten Hacken NH, Postma DS, et al. Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: a systematic review[J]. Allergy Clin Immunol, 2013, 131(3): 646-657.
[21] Balzar S, Wenzel SE, Chu HW. Transbronchial biopsy as a tool to evaluate small airways in asthma[J]. Eur Respir J, 2002, 20(2): 254-259.
[22] Sunyer J, Jarvis D, Pekkanen J, et al. Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study[J]. Allergy Clin Immunol, 2004, 114(5): 1033-1039.
[23] Patelis A, Gunnbjörnsdottir M, Malinovschi A,et al. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness[J]. Allergy Clin Immunol, 2012, 130(2): 397-402.
[24] Schiphof-Godart L, van der Wiel E, Ten Hacken NH, et al. Development of a tool to recognize small airways dysfunction in asthma(SADT)[J]. Health Qual Life Out, 2014, 12: 155. doi: 10.1186/s12955-014-0155-7.
[25] Thompson BR, Douglass JA, Ellis MJ, et al. Peripheral lung function in patients with stable and unstable asthma[J]. Allergy Clin Immunol, 2013, 131(5): 1322-1328.
[26] Rao DR, Gaffin JM, Baxi SN, et al. The utility of forced expiratory flow between 25% and 75% of vital capacity in predicting childhood asthma morbidity and severity[J]. Asthma, 2012, 49(6): 586-592.
[27] Pisi R, Tzani P, Aiello M, et al.Small airway dysfunction by impulse oscillometry in asthmatic patients with normal forced expiratory volume in the 1st second values[J]. Allergy Asthma Proc, 2013, 34(1): e14-e20.
[28] Perez T, Chanez P, Dusser D, et al. Small airway impairment in moderate to severe asthmatics without significant proximal airway obstruction[J]. Respir Med, 2013, 107(11): 1667-1674.
[29] Klug B, Bisgaard H. Measurement of lung function in awake 2-4-year-old asthmatic children during methacholine challenge and acute asthma: a comparison of the impulse oscillation technique, the interrupter technique, and transcutaneous measurement of oxygen versus whole-body plethysmography[J]. Pediatr Pulm, 1996, 21(5): 290-300.
[30] Paredi P, Goldman M, Alamen A, et al. Comparison of inspiratory and expiratory resistance and reactance in patients with asthma and chronic obstructive pulmonary disease[J]. Thorax, 2010, 65(3): 263-267.
[31] Gonem S, Natarajan S, Desai D, et al. Clinical significance of small airway obstruction markers in patients with asthma[J]. Clin Exp Allergy, 2014, 44(4): 499-507.
[32] Lipworth B. Targeting the small airways asthma phenotype: if we can reach it, should we treat it?[J]. Ann Allergy Asthma Immunol, 2013, 110(4): 233-239.
[33] Goldman MD, Saadeh C, Ross D. Clinical applications of forced oscillation to assess peripheral airway function[J]. Respir Physiol Neurobiol, 2005, 148(1-2): 179-194.
[34] Anderson WJ, Zajda E, Lipworth BJ. Are we overlooking persistent small airways dysfunction in community-managed asthma?[J]. Ann Allergy Asthma Immunol, 2012, 109(3): 185-189.
[35] Lee JH, Lee YW, Shin YS, et al. Exercise-induced airway obstruction in young asthmatics measured by impulse oscillometry[J]. Investig Allergol Clin Immunol, 2010, 20(7): 575-581.
[36] Juniper EF, Bousquet J, Abetz L, et al. GOAL Committee. Identifying ‘well-controlled’ and ‘not well-controlled’ asthma using the Asthma Control Questionnaire[J]. Respir Med, 2006, 100(4): 616-621.

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