2023 年第 2 期 第 18 卷

呼出气一氧化氮浓度检测在嗜酸性气道炎症表型支气管扩张症患者中的意义

Significance of fractional exhaled nitric oxide concentration detection in patients with eosinophilic airway inflammation phenotype of bronchiectasis

作者：宛莹华张明强郭文佳赵丽娜牟向东

英文作者：Wan Yinghua Zhang Mingqiang Guo Wenjia Zhao Lina Mu Xiangdong

单位：清华大学附属北京清华长庚医院呼吸与危重症医学科清华大学临床医学院，北京102218

英文单位：Department of Respiratory and Critical Care Medicine Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Beijing 102218 China

关键词：支气管扩张症；呼出气一氧化氮；嗜酸性气道炎症表型；Reiff评分；嗜酸性粒细胞计数

英文关键词：Bronchiectasis;Fractionalexhalednitricoxide;Eosinophilicairwayinflammationphenotype;Reiffscore;Eosinophilcount

• 摘要：

• 目的 探讨呼出气一氧化氮（FeNO）浓度检测在嗜酸性气道炎症表型支气管扩张症患者中的意义。方法 选取2019年1月至2020年1月清华大学附属北京清华长庚医院收治的支气管扩张症患者108例，收集其临床表现、既往病史、同时期FeNO、血清免疫球蛋白E（IgE）、肺功能检查结果等资料行回顾性分析。结果 108例患者中共67例患者完善了结核相关检查（62.0%），其中结核感染者30例，占44.8%；54例患者完善了FeNO检查，11例结果异常，占20.4%；76例显示有阻塞性通气功能障碍，占70.4%；共45例完善了血清IgE检查，结果异常者17例，占37.8%。相关性分析结果显示FeNO浓度与嗜酸性粒细胞计数呈明显正相关（r=0.043，P<0.001)。FeNO浓度与Reiff评分呈负相关（r=-0.326，P=0.016）、与第1秒用力呼气容积占预计值百分比（FEV1%）呈正相关（r=0.290，P=0.048），FEV1%与Reiff评分呈负相关 (r=-2.483，P＜0.001)。在吸烟、结核感染及IgE异常3个因素中，FeNO浓度仅与IgE异常相关，IgE升高者FeNO浓度大于IgE正常者［（52±25）ppb比（19±10）ppb］，差异有统计学意义（P＜0.001）。结论 嗜酸性气道炎症表型支气管扩张症与过敏反应相关，FeNO浓度在此类患者中升高，在临床诊疗中具有指示性意义。

• Objective To explore the significance of fractional exhaled nitric oxide(FeNO) concentration detection in patients with eosinophilic airway inflammation phenotype of bronchiectasis. Methods  Totally 108 patients with bronchiectasis admitted to Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2019 to January 2020 were selected. Their clinical manifestations, previous medical history, FeNO, serum immunoglobulin E(IgE), lung function and other data were collected for retrospective analysis. Results  There were 67 patients(62.0%) completed tuberculosis related examinations, of which 30 patients were infected with tuberculosis, accounting for 44.8%; FeNO examination was completed in 54 patients, and 11 of them had abnormal results, accounting for 20.4%; 76 patients had obstructive ventilatory dysfunction, accounting for 70.4%; 45 patients completed the serum IgE test, and 17 of them were abnormal, accounting for 37.8%. The correlation analysis showed that FeNO concentration was positively correlated with eosinophil count (r=0.043, P<0.001). FeNO concentration was negatively correlated with Reiff score(r=-0.326, P=0.016), and was positively correlated with the percentage of forced expiratory volume in the first second in the predicted value (FEV1%)(r=0.290, P=0.048). FEV1% was negatively correlated with Reiff score(r=-2.483, P<0.001). Among the three factors of smoking, tuberculosis infection and abnormal IgE, FeNO concentration was only related to abnormal IgE. FeNO concentration in patients with elevated IgE was higher than that in patients with normal IgE［(52±25) ppb vs (19±10) ppb］(P<0.001). Conclusion  The eosinophilic airway inflammatory phenotype of bronchiectasis is related to allergic reaction, and the concentration of FeNO increases in such patients, which has an indicative significance in clinical diagnosis and treatment.