Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children
Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children
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DOI：
10.1016/j.jaci.2003.08.014
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发表时间：
2003-11-01
影响因子：
14.2
通讯作者：
Lemanske, RF
中科院分区：
文献类型：
--
作者：
Strunk, RC;Szefler, SJ;Lemanske, RF
背景：呼出一氧化氮（eNO）是一种非侵入性检测气道炎症的方法。关于eNO与目前未服用控制药物的哮喘儿童的生物学、生理学和临床特征之间的相关性的信息不足。目的：本研究的目的是确定目前未服用药物的轻度至中度哮喘儿童的eNO与其他特征之间的相关性。方法：年龄在6 - 17岁之间的轻度至中度持续性哮喘儿童，根据需要仅服用沙丁胺醇，在随机分配到临床试验之前，在间隔1周的2次访视期间进行特征描述。在筛选访视时，在线测量eNO、使用支气管扩张剂前后的肺功能测定、外周血嗜酸性粒细胞生物标志物、血清嗜酸性粒细胞阳离子蛋白、血清总IgE和尿白三烯E-4。在随机化前的一周表征期间，在日记上记录症状，并使用电子设备每天两次测量呼气峰流量。在随机化访视时，重复eNO，然后进行乙酰甲胆碱激发和空气过敏原皮肤试验。评估eNO与临床特征、肺功能和生物标志物之间的相关性和秩回归分析。eNO与外周血嗜酸性粒细胞显著相关（r = .51，P < .0001），IgE（r = 0.48，P <0.0001）和血清嗜酸性粒细胞阳离子蛋白（r = 0.31，P = 0.0003），但与尿白三烯E4无相关性（r = 0.16，P = 0.08）。在eNO和阳性吸入性变应原皮试的数量之间发现了中度相关性（r = 0.45，P <0.0001）。eNO与FEV1%预测值无关，但与FEV 1/用力肺活量（r = -.19，P = .032）、支气管扩张剂反应（r = .20，P = .023）和FEV 1 PC 20乙酰甲胆碱（r = -.31，P = .0005）弱相关。未发现eNO与临床特征或早晚呼气峰流速测量之间存在显著相关性。秩和回归分析表明，5个变量的R平方为0.52（嗜酸性粒细胞[P < .0001]、IgE [P = .0023]、年龄[P < .0001]、研究入组前一年吸入皮质类固醇的月数[P = .01]和FEV 1 PC 20 [P = .0061]）。这些发现表明，eNO提供的哮喘状态的信息与其他炎症标志物的信息一致。它是一种无创性的技术，可用于儿童哮喘的决策管理。
Background: Exhaled nitric oxide (eNO) is a noninvasive test that measures airway inflammation. Insufficient information is available concerning correlations between eNO and biologic, physiologic, and clinical characteristics of asthma in children currently not taking controller medications.Objective: The aim of this study was to rind correlations between eNO and other characteristics of children with mild to moderate asthma currently not taking medications.Methods: Children aged 6 to 17 years with mild to moderate persistent asthma, taking only albuterol as needed, were characterized during 2 visits 1 week apart before being randomly assigned into a clinical trial. At the screening visit, online measurements of eNO, spirometry before and after bronchodilator, and biomarkers of peripheral blood eosinophils, serum eosinophil cationic protein, total serum IgE, and urinary leukotriene E-4 were obtained. During a week characterization period before randomization, symptoms were recorded on a diary and peak expiratory flows were measured twice daily using an electronic device. At the randomization visit, eNO was repeated followed by a methacholine challenge and aeroallergen skin testing. Correlations and rank regression analyses between eNO and clinical characteristics, pulmonary function, and biomarkers were evaluated.Results: eNO was significantly correlated with peripheral blood eosinophils (r = .51, P < .0001), IgE (r = .48, P < .0001), and serum eosinophil cationic protein (r = .31, P = .0003) but not with urinary leukotriene E4 (r = .16, P = .08). A moderate correlation was found between eNO and the number of positive aeroallergen skin tests (r = .45, P < .0001). eNO did not correlate with FEV1 % predicted but was weakly correlated with FEV1/forced vital capacity (r = -.19, P = .032), bronchodilator response (r = .20, P = .023), and FEV1 PC20 methacholine (r = -.31, P = .0005). No significant correlations were found between eNO and clinical characteristics or morning or evening peak expiratory flow measurements. The rank regression analysis demonstrated that 5 variables accounted for an R square of .52 (eosinophils [P < .0001], IgE [P = .0023]age [P < .0001], months of inhaled corticosteroid use in the year before study entry [P = .01], and FEV1 PC20 [P = .0061]).Conclusions: These findings suggest that eNO provides information about the asthmatic state consistent with information from other markers of inflammation. It is a noninvasive technique that could be used in decisional management of children with asthma.