课件：一氧化氮呼气测定的临床意义和应用.ppt

现在问题，大部分医院没有办法做诱导痰及激发试验 * 国外资料显示,慢性咳嗽的病因,组成,哮喘综合症占25%, 胃食道返流占20%, 鼻炎占34%, 其中只有哮喘综合症病人及过敏性鼻炎患者FeNO增高, * * 结果显示CVA/EB患者痰中嗜酸粒细胞（4.2)水平高于正常人群(0.3) （p0.001） 。 * * 最新的资料显示： 结合诱导痰检查,发现当FeNO的折点在FeNO26ppb的时候,可以判断其是嗜酸性气道炎症, 诱导痰检查的阴性排除率为85%, 意味着只有15%左右的嗜酸性气道炎症患者的FeNO值低于26ppb, This means that 15-20%of individuals will have a FENO which is in the “pathological” range even if they are healthy 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 bor