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  • 成青,董冉,丁红梅,等.呼出气一氧化氮对激素敏感性咳嗽诊断的预测价值[J].同济大学学报(医学版),2021,42(1):92-96,102.    [点击复制]
  • CHENG Qing,DONG Ran,DING Hong-mei,et al.Diagnostic value of fractional exhaled nitric oxide for corticosteroid-responsive cough[J].同济大学学报(医学版),2021,42(1):92-96,102.   [点击复制]
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呼出气一氧化氮对激素敏感性咳嗽诊断的预测价值
成青,董冉,丁红梅,潘静,邱忠民
0
(上海市普陀区利群医院·海军军医大学利群临床医学院呼吸科,上海200333;同济大学附属同济医院呼吸与危重症医学科,上海200065;同济大学附属同济医院呼吸与危重症医学科,上海200066;同济大学附属同济医院呼吸与危重症医学科,上海200067;同济大学附属同济医院呼吸与危重症医学科,上海200068)
摘要:
目的探讨呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)对激素敏感性咳嗽的预测诊断价值。方法选择2016年1月—2017年10月在同济大学附属同济医院呼吸与危重症学科门诊就诊的194例慢性咳嗽病例,比较激素敏感性咳嗽和非激素敏感性咳嗽FeNO的差异,分析FeNO与诱导痰嗜酸粒细胞比例的相关性以及对激素敏感性咳嗽的预测诊断价值。结果激素敏感性咳嗽的FeNO明显高于非激素敏感性咳嗽[(46.96±50)ppb vs (23±16.8)ppb,t=2.9,P=0.004],其中咳嗽变异性哮喘和嗜酸粒细胞性支气管炎的FeNO高于其它病因(F=4.5,P=0.002),但咳嗽变异性哮喘、嗜酸粒细胞性支气管炎和变应性咳嗽之间FeNO并无差别(F=2.7,P=0.07)。激素敏感性咳嗽FeNO与诱导痰嗜酸粒细胞比例存在正相关(r=0.291,P=0.002)。ROC分析显示以≥29.5ppb作为临界值,FeNO诊断激素敏感性咳嗽的灵敏度为55%,特异度为93%,阳性预计值55%,阴性预计值92%,ROC曲线下面积为0.824。结论FeNO对激素敏感性咳嗽具有一定的预测诊断价值,可以指导慢性咳嗽的激素治疗。
关键词:  慢性咳嗽  激素敏感性咳嗽  呼出气一氧化氮  嗜酸粒细胞  诱导痰
DOI:10.12289/j.issn.1008-0392.20261
投稿时间:2020-06-11
基金项目:国家自然科学基金面上项目(81670092)
Diagnostic value of fractional exhaled nitric oxide for corticosteroid-responsive cough
CHENG Qing,DONG Ran,DING Hong-mei,PAN Jing,QIU Zhong-min
(Dept. of Respiratory Medicine, Shanghai Liqun Hospital of Putuo District, Shanghai 200333, China;Dept. of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China)
Abstract:
ObjectiveTo explore the diagnostic value of fractional exhaled nitric oxide (FeNO) in corticosteroid-responsive cough. MethodsOne hundred and ninety four patients with chronic cough referred to Respiratory Clinic of Tongji Hospital, Tongji University School of Medicine from January 2016 to October 2017 were recruited for the retrospective study. The difference in FeNO between corticosteroid-responsive cough and non-corticosteroid-responsive cough was compared, and the correlation of FeNO with eosinophilic percentage in induced sputum was analyzed. Then, the value of FeNO in the diagnosis of corticosteroid-responsive cough was analyzed by receiver operating characteristic (ROC) curve. ResultsFeNO was significantly higher in corticosteroid-responsive cough than that in non-corticosteroid-responsive cough [(46.96±50) ppb vs (23±16.8) ppb, t=2.9, P=0.004]. FeNO in cough variant asthma and eosinophilic bronchitis was higher than that in the other causes (F=4.5, P=0.002). There was no significant difference in FeNO level among cough variant asthma, eosinophilic bronchitis and atopic cough (F=2.7, P=0.07). The area under ROC curve (AUC) of FeNO was 0.824 for diagnosis of corticosteroid-responsive cough; the cutoff point of FeNO was defined as ≥29.5 ppb with a sensitivity of 55%, specificity of 93%, positive predictive value of 92% and negative predictive value of 92% in diagnosis of corticosteroid-responsive cough. ConclusionFeNO has a certain value for the diagnosis of corticosteroid-responsive cough and can be used as an indicator of corticosteroid treatment for chronic cough.
Key words:  chronic cough  corticosteroid-responsive cough  fractional exhaled nitric oxide  eosinophils  induced sputum

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