Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma.
Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma.
复制标题
肺活量测定、呼出一氧化氮分数和循环嗜酸性粒细胞中的小气道功能变量可预测轻度哮喘患者的气道高反应性
DOI：
10.2147/jaa.s295345
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发表时间：
2021
影响因子：
3.2
通讯作者：
Zhang M
中科院分区：
文献类型：
--
作者：
Bao W;Zhang X;Yin J;Han L;Huang Z;Bao L;Lv C;Hao H;Xue Y;Zhou X;Zhang M
有类似哮喘的多变症状但一秒用力呼气量（FEV1）正常的患者，若不进行支气管激发试验，往往难以确诊。然而，该试验费用高昂、耗时较长、存在风险，且并非在所有临床环境中都能轻易开展。
对692例FEV1≥预计值80%、中性粒细胞和胸部高分辨率计算机断层扫描正常，且反复出现呼吸困难、咳嗽、喘息和胸闷症状的患者进行了一项横断面研究。
与气道高反应性（AHR）阴性的受试者（n = 522）相比，AHR阳性的受试者（n = 170）呼出气一氧化氮（FENO）值、外周血嗜酸性粒细胞（EOS）计数和R5 - R20升高；FEV1、FEV1/用力肺活量（FVC）和用力呼气流量（FEFs）降低（所有P≤0.001）。104例AHR阳性患者（61.17%）和132例AHR阴性患者（25.29%）存在小气道功能障碍（P < 0.001）。单独用于诊断AHR的各变量的曲线下面积（AUC）均低于0.77。FEF50%、FEF75%或FEF25% - 75%与FENO联合模型的AUC分别增至0.845、0.824和0.844，显著高于单变量AUC（所有P < 0.001）。自述有胸闷症状的患者（n = 75）FEFs低于无胸闷症状的患者（所有P < 0.001）。在有胸闷症状的受试者中，FEF50%或FEF25% - 75%与EOS联合也大幅提高了AUC，分别达到0.815和0.816（与单变量AUC相比，所有P < 0.001）。
FENO联合FEF50%和FEF25% - 75%可预测FEV1正常患者的AHR。FEF25% - 75%、FEF50%或FEF25% - 75%与EOS联合也可能提示有胸闷症状患者患有哮喘。
Purpose Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV1) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky, and not readily available in all clinical settings. Patients and Methods A cross-sectional study was performed in 692 patients with FEV1≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness. Results Compared with subjects negative for AHR (n=522), subjects positive for AHR (n=170) showed increased FENO values, peripheral eosinophils (EOS), and R5-R20; decreased FEV1, FEV1/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (P≤.001 for all). Small-airway dysfunction was identified in 104 AHR+ patients (61.17%), and 132 AHR− patients (25.29%) (P<0.001). The areas under the curve (AUCs) of variables used singly for an AHR diagnosis were lower than 0.77. Using joint models of FEF50%, FEF75%, or FEF25%-75% with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs (P <0.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (P<0.001 for all). In subjects with chest tightness, the combination of FEF50% or FEF25%-75% with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively (P <0.001 for all versus the univariate AUCs). Conclusion FENO combined with FEF50% and FEF25%-75% predict AHR in patients with normal FEV1. FEF25%-75%, FEF50%, or FEF25%-75% together with EOS also can potentially suggest asthma in patients with chest tightness.