Use of Nasal Nitric Oxide in the Diagnosis of Allergic Rhinitis and Nonallergic Rhinitis in Patients with and without Sinus Inflammation
Use of Nasal Nitric Oxide in the Diagnosis of Allergic Rhinitis and Nonallergic Rhinitis in Patients with and without Sinus Inflammation
复制标题
鼻腔一氧化氮在诊断有或没有鼻窦炎症的过敏性鼻炎和非过敏性鼻炎中的应用
DOI：
10.1016/j.jaip.2019.12.017
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发表时间：
2020-05-01
影响因子：
9.4
通讯作者：
Zhang, Luo
中科院分区：
文献类型：
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作者：
Liu, Chengyao;Zheng, Kaili;Zhang, Luo
研究背景：对伴有和不伴有鼻息肉的慢性鼻窦炎患者的鼻一氧化氮（nNO）进行了评估。然而，在以往的研究中，过敏性鼻炎（AR）和非过敏性鼻炎（NAR）患者的nNO水平显示出相互矛盾的结果。目的评价nNO对AR和NAR的诊断价值及有无鼻窦炎症（SI）的影响。方法选取连续173例高分辨率计算机断层扫描（CT）患者和46例正常对照（nc）进行研究。根据患者的病史、鼻症状、内窥镜检查和皮肤点刺试验结果对患者进行评估。根据CT扫描结果（Lund-Mackay评分bb0.2），将所有患者分组为AR合并SI （ARwSI）和AR无SI (ARsSI)，或NAR合并SI （NARwSI）和NAR无SI （NARsSI）。用NIOX测定nNO水平，同时测定鼻涂片中嗜酸性粒细胞。进行受体操作特征分析，以鉴别AR、NAR和亚组。结果94例诊断为AR， 79例诊断为NAR。AR患者和NCs患者的nNO水平明显高于NAR患者（AR为939±335，NCs为813±272，NAR为670±188，P< 0.001）， AR患者的nNO水平明显高于NCs （P< 0.05）。根据鼻窦CT扫描，49%的AR患者（94例中的46例）被定义为ARwSI， 51%的NAR患者（79例中的40例）被定义为NARwSI。与其他亚组相比，ARsSI患者nNO水平最高（1180±289）（P< 0.001）， NARwSI患者nNO水平最低（522±120）（P< 0.001）。nNO可用于区分AR、NAR和亚组，具有可接受的敏感性和特异性。鼻涂片嗜酸性粒细胞增多患者的nNO水平低于NAR患者（P< 0.05）。结论ARwSI/ARsSI和NARwSI/NARsSI患者的snno水平存在差异，可能用于区分这些表型。
BackgroundNasal nitric oxide (nNO) has been evaluated in patients with chronic rhinosinusitis with and without nasal polyps. However, nNO levels in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR) have shown conflicting results in previous studies.ObjectiveTo evaluate the value of nNO in diagnosing AR and NAR and the impact of absence or presence of sinus inflammation (SI).MethodsA total of 173 consecutive patients scanned with high-resolution computed tomography (CT) and 46 normal controls (NCs) were included in our study. Patients were evaluated according to their medical history, nasal symptoms, endoscopic examinations, and skin prick test results. On the basis of CT scans (Lund-Mackay score >2), all patients were subgrouped as AR with SI (ARwSI) and AR without SI (ARsSI), or NAR with SI (NARwSI) and NAR without SI (NARsSI). nNO levels were measured with the NIOX, and eosinophils in nasal smears were evaluated simultaneously. Receiver-operating characteristic analysis was performed for differential diagnosis of AR, NAR, and subgroups.ResultsNinety-four patients were diagnosed with AR and 79 patients with NAR. The levels of nNO were significantly higher in patients with AR and in NCs compared with patients with NAR (939 ± 335 in AR and 813 ± 272 in NCs vs 670 ± 188 in NAR;P< .001 for both), and significantly higher in patients with AR compared with NCs (P< .05). On the basis of sinus CT scans, 49% patients with AR (46 of 94) were defined as ARwSI and 51% patients with NAR (40 of 79) were defined as NARwSI. Patients with ARsSI showed the highest nNO levels (1180 ± 289) compared with other subgroups (P< .001), and patients with NARwSI showed the lowest nNO levels (522 ± 120) compared with other subgroups (P< .001). nNO could be used to discriminate AR, NAR, and subgroups with acceptable sensitivity and specificity. Moreover, patients with nasal smear eosinophilia had lower nNO levels than did patients with NAR (P< .05).ConclusionsnNO levels are different between patients with ARwSI/ARsSI and NARwSI/NARsSI, and may be used to discriminate these phenotypes.