一氧化氮呼气测定的临床意义和应用-1.ppt

区分慢性咳嗽患者中是为嗜酸性气道炎症，优化截断值（拐点）为33 ppb。GERD的患者中，伴有嗜酸性气道炎症的患者其FeNO平均为40.5 ppb，而不伴有嗜酸性气道炎症的患者为19.5 ppb。 The cut-off point on the ENO ROC curve for differ-entiating chronic cough patients with or without EAI was 33 ppb. This value of ENO showed a sensitivity of 60.5% and a speci?city of 84.6% (positive predictive value 65.7%; negative predictive value 81.4%) * 咳嗽变异性哮喘及哮喘病人的FeNO明显高于变应性咳嗽患者, Exhaled NO levels in patients with AC (13.0 p.p.b., GSEM 1.14) were signi?cantly lower than those in patients with CVA (39.4 p.p.b., GSEM 1.25, P = 0.0007) or BA (36.1 p.p.b., GSEM 1.26, P = 0.0020) (Fig. 1). There was no signi?cant difference in the exhaled NO levels between patients with CVA and BA (P = 0.7618). * 在三类患者中，支气管哮喘和EB患者的FeNO值显著增高。当FeNO的值31.7ppb的时候，其诊断为非EB的预测值为95% The exhaled NO value 31.7 ppb in nonasthmatic patients with chronic cough had a high negative predictive value (95%), reasonable specificity (76%), and a helpful negative likelihood ratio (0.19) for determining the absence of NAEB. * 64名使用ICS治疗的患者中，41患者的FeNO水平超过35ppb， 其中36人（88%）的症状显著改善，5人（12%）对ICS无反应。FeNO水平低于35ppb的23人中， 2人（9%）症状显著改善，21人（91%）咳嗽症状未改善。综合分析，对ICS反应的最佳阶段值在38ppb. * ICS治疗组：对症治疗2周后咳嗽持续且FeNO=30 ppb，支气管激发试验临界阳性或阳性，或FEV1/FVC = 70%者用福替卡松，250mg每日2吸，至少2周。 ICS治疗组中44名患者，经过治疗后38人症状完全控制，6人对激素反应不佳。经过分析，使用激素治疗反应好的FeNO优化起始水平为33.9 ppb ICS treatment by Fluticasone Accuhaler (GlaxoSmithKline, Greenford Middlesex, UK) with a 250 m g per dose oral inhalation of one puff twice daily was prescribed for at least 2 weeks if the cough persisted after initial symptomatic treatment and if the FeNO level was 30 ppb or more, if there was borderline to positive BHR, or if baseline ratio of FEV 1 to forced vital capacity was less than 70%. * ATS指南，使用FeNO20 儿童，》25 成人，作为折点 但有小样本研究显示FeNO30 更有可能是CVA/EB * ATS指南，使用FeNO20 儿童，》25 成人，作为折点 但有小样本研究显示FeNO30 更有可能是CVA/EB * 痰 中 嗜 酸 粒 细 胞 (%) CVA/EB患者嗜酸粒细胞水平高于正常人群 Birring SS et al. Am J Reapir Crit Care Med, 2004; 169: 15-19 0.3 4.2 0.3 0 0.4 0.8 1.2 1.6 2.0 2.4 2.8 3.2 3.6 4.0 CVA/EB 非哮喘性