Koek G H, Verleden G M, Evenepoel P, Rutgeerts P
Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium.
Respir Med. 2002 Jul;96(7):530-5. doi: 10.1053/rmed.2002.1312.
Nitric oxide (NO) is an important mediator of inflammation in several pathological conditions. Patients with lung diseases, like asthma, have higher levels of exhaled NO (eNO) in active disease in comparison with healthy volunteers. Aspirated colonic gas in patients with ulcerative colitis (UC) showed more than 100 times higher levels of NO in comparison with normal subjects. Crohn's disease (CD) and UC are associated with a variety of systemic manifestations, although lung diseases as an extra-intestinal expression of inflammatory bowel disease (IBD) are not well investigated. In some studies, clinical and subclinical pulmonary abnormalities are described in active IBD as well as in the stable situation. The aim of the present study is to evaluate whether eNO is increased in patients with active IBD and to investigate whether there exists a correlation between (1) the eNO levels and the disease activity, and (2) the spirometry and the disease activity in a subgroup of patients. In 31 patients with CD (mean age 36.8 +/- 12.9 years) and 24 patients with UC (mean age 38.0 +/- 14.7 years) the Crohn's Disease Activity Index (CDAI) and Colitis Activity Index (CAI) were measured, respectively. Exhaled NO was measured with a chemiluminescence analyzer, according to standardized criteria. In a subgroup of CD patients, spirometry was also performed according to standardized criteria. The mean CDAI in CD patients was 192.4 +/- 94.3 and their mean eNO value was 13.5 +/- 4.6 ppb. For UC the mean CAI was 6.2 +/- 4.8 and the mean eNO value was 15.8 +/- 6.2 ppb. In a matched control group of 27 healthy, non-smoking volunteers (mean age of 33.7 +/- 13.2 years) the eNO was 10.2 +/- 2.5 ppb (P < 0.05 compared to CD and P < 0.01 compared to UC). There was a disease-activity-related increase of the eNO level in patients with IBD. For patients with UC the correlation coefficient (r = 0.63, P < 0.001) was more pronounced than for CD (r = 0.39, P < 0.05). In 17 patients with CD, spirometry was available at the time of the eNO measurement. We found a significant negative correlation between the CDAI and the FEV1 and FVC in these patients (r = -0.559, P = 0.02 and r = -0.634, P = 0.006, respectively). We conclude that eNO is increased in active IBD and correlates with the activity of the disease; furthermore, we found a negative correlation between spirometry and disease activity in patients with CD. These observations strengthen the arguments that IBD is a systemic disease. Further research is needed to try to explain the significance of an increased eNO in IBD.
一氧化氮（NO）是多种病理状态下炎症的重要介质。患有肺部疾病（如哮喘）的患者，在疾病活动期呼出的一氧化氮（eNO）水平高于健康志愿者。与正常受试者相比，溃疡性结肠炎（UC）患者吸入的结肠气体中NO水平高出100多倍。克罗恩病（CD）和UC与多种全身表现相关，尽管作为炎症性肠病（IBD）肠外表现的肺部疾病尚未得到充分研究。在一些研究中，无论是在IBD活动期还是稳定期，均描述了临床和亚临床肺部异常情况。本研究的目的是评估活动期IBD患者的eNO水平是否升高，并调查（1）eNO水平与疾病活动度之间，以及（2）一组患者的肺功能测定与疾病活动度之间是否存在相关性。分别对31例CD患者（平均年龄36.8±12.9岁）和24例UC患者（平均年龄38.0±14.7岁）测量了克罗恩病活动指数（CDAI）和结肠炎活动指数（CAI）。根据标准化标准，使用化学发光分析仪测量呼出的NO。在一组CD患者中，也根据标准化标准进行了肺功能测定。CD患者的平均CDAI为192.4±94.3，其平均eNO值为13.5±4.6 ppb。UC患者的平均CAI为6.2±4.8，平均eNO值为15.8±6.2 ppb。在由27名健康、不吸烟志愿者组成的匹配对照组（平均年龄33.7±13.2岁）中，eNO为10.2±2.5 ppb（与CD组相比P<0.05，与UC组相比P<0.01）。IBD患者的eNO水平存在与疾病活动相关的升高。UC患者的相关系数（r = 0.63，P<0.001）比CD患者（r = 0.39，P<0.05）更显著。在17例CD患者中，在测量eNO时可进行肺功能测定。我们发现这些患者的CDAI与FEV1和FVC之间存在显著负相关（分别为r = -0.559，P = 0.02和r = -0.634，P = 0.006）。我们得出结论，活动期IBD患者的eNO升高且与疾病活动度相关；此外，我们发现CD患者的肺功能测定与疾病活动度之间存在负相关。这些观察结果支持了IBD是一种全身性疾病的观点。需要进一步研究以试图解释IBD中eNO升高的意义。
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