摘要： 目的 分析呼出气一氧化氮（FeNO）检测与稳定期慢性阻塞性肺疾病（COPD）患者小气道改变及预后的相关性。方法 收集156例稳定期COPD患者的临床资料，分析患者FeNO与第1秒用力肺活量占预计值的百分比（FEV1% pred）、FEV1与用力肺活量（FVC）的比值（FEV1/FVC）及小气道改变［25%肺活量时的最大呼气流速占预计值百分比（MEF25% pred）、50%肺活量时的最大呼气流速占预计值百分比（MEF50% pred）、75%肺活量时的最大呼气流速占预计值百分比（MEF75% pred） ］的相关性。根据受试者操作特征曲线评估FeNO诊断稳定期重度COPD的截断值，将156例COPD患者分为高FeNO组与低FeNO组，比较随访12个月内急性加重次数和未急性加重生存时间的差异。结果 Pearson相关分析显示，稳定期COPD患者中FeNO与FEV1% pred FEV1/FVC、MEF25% pred、MEF50% pred、MEF75% pred均呈明显负相关（P<0.001）。随访12个月内，高FeNO组急性加重次数明显高于低FeNO组（P<0.001），其未急性加重生存时间明显低于低FeNO组（P<0.001）。结论 FeNO与稳定期COPD小气道改变密切相关，能辅助判断患者急性加重情况。

呼出气一氧化氮检测与稳定期慢性阻塞性肺疾病患者小气道改变及预后的相关性

崔可慧¹, 苏新明²

1. 中国医科大学附属第四医院第一呼吸与危重症医学科, 沈阳 110034;
2. 中国医科大学附属第一医院呼吸与危重症医学科, 沈阳 110001

收稿日期:2022-05-25出版日期:2023-01-30发布日期:2023-02-01
通讯作者:苏新明E-mail:xinming_s@163.com
作者简介:崔可慧（1989-），女，医师，硕士研究生.
基金资助:国家自然科学基金（82170038）


关键词: 慢性阻塞性肺疾病, 呼出气一氧化氮, 小气道, 急性加重
Abstract: Objective To analyze the correlation between fractional exhaled nitric oxide (FeNO) detection and small airway changes and the prognosis of patients with stable chronic obstructive pulmonary disease (COPD). Methods The clinical data of 156 patients with stable COPD were collected. We subsequently analyzed the correlation between FeNO and forced vital capacity in the first second as a percentage of predicted value (FEV1%pred), the ratio of FEV1 to forced vital capacity (FVC) (FEV1/FVC), and small airway changes including maximal expiratory flow in 25% vital capacity of the predicted value (MEF25%pred), maximal expiratory flow in 50% vital capacity of the predicted value (MEF50%pred), and maximal expiratory flow in 75% vital capacity of the predicted value (MEF75%pred). The cut-off value of FeNO in diagnosing severe stable COPD was evaluated using receiver operating characteristic curve. Overall, 156 patients with COPD were divided into the high and low FeNO groups, and the number of acute exacerbations within 12 months of follow-up and survival time without acute exacerbation were compared. Results Pearson correlation analysis showed that FeNO was significantly negatively correlated with FEV1%pred, FEV1/FVC, MEF25%pred, MEF50%pred, and MEF75%pred in patients with stable COPD (P<0.001). Within 12 months of follow-up, the number of acute exacerbations in the high FeNO group was significantly higher (P<0.001), and the survival time without acute exacerbation was significantly shorter (P<0.001) compared to the low FeNO group. Conclusion FeNO is closely related to small airway changes in stable COPD and can be used to help predict the prognosis of patients with stable COPD.
Key words: chronic obstructive pulmonary disease, fractional exhaled nitric oxide, small airway, acute exacerbation
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