Lex Christiane, Ferreira Flavia, Zacharasiewicz Angela, Nicholson Andrew G, Haslam Patricia L, Wilson Nicola M, Hansel Trevor T, Payne Donald N R, Bush Andrew
Department of Pediatric Respiratory Medicine, Imperial College of Science, Technology, and Medicine at the Royal Brompton Hospital and National Heart and Lung Institute, Sydney Street, London SW3 6NP, UK.
Am J Respir Crit Care Med. 2006 Dec 15;174(12):1286-91. doi: 10.1164/rccm.200603-352OC. Epub 2006 Sep 14.
Children with severe asthma experience persistent symptoms despite maximal conventional treatment. Fraction of exhaled nitric oxide (Fe(NO)) and sputum eosinophils are used as markers of airway inflammation to guide treatment with steroids, but no data are available on how reliable they are in predicting airway eosinophilia assessed bronchoscopically in these children.
To determine how Fe(NO) and sputum eosinophils predict airway eosinophilia measured in both bronchoalveolar lavage (BAL) and endobronchial biopsy.
Twenty-seven children with moderate to severe persistent asthma attempted measurement of Fe(NO) and sputum eosinophils, followed by bronchoscopy, BAL, and endobronchial biopsy within 24 h.
Significant correlations were found between eosinophils in sputum and both BAL eosinophils (n = 20, r = 0.45, p = 0.045) and Fe(NO) (n = 23, r = 0.42, p = 0.049). The relationship between Fe(NO) and BAL eosinophils was also significant with a stronger correlation (n = 24, r = 0.54, p = 0.006). The positive predictive value (PPV) for increased sputum eosinophil percentage (> 2.5%) to detect elevated eosinophils in BAL (> 1.19%) was 75%; the negative predictive value (NPV) was 63%. All patients with both increased sputum eosinophils and an elevated Fe(NO) value (> 23 ppb) had elevated eosinophils in BAL (PPV, 100%); the NPV of these two markers was 65%. Eight of nine patients without any sputum eosinophils had normal subepithelial eosinophil numbers (< 1.2%; NPV, 89%). However, the PPV of any sputum eosinophils for increased subepithelial eosinophilia was only 36.4%.
There was moderate agreement between both Fe(NO) and sputum eosinophils and BAL eosinophils. There was good NPV, but only poor PPV for these markers for mucosal eosinophilia.
尽管接受了最大程度的传统治疗，重度哮喘患儿仍有持续症状。呼出一氧化氮分数（Fe(NO)）和痰液嗜酸性粒细胞用作气道炎症标志物以指导类固醇治疗，但尚无关于它们在预测这些患儿经支气管镜评估的气道嗜酸性粒细胞增多方面可靠性的数据。
确定Fe(NO)和痰液嗜酸性粒细胞如何预测支气管肺泡灌洗（BAL）和支气管活检中测得的气道嗜酸性粒细胞增多情况。
27例中度至重度持续性哮喘患儿尝试测量Fe(NO)和痰液嗜酸性粒细胞，随后在24小时内进行支气管镜检查、BAL和支气管活检。
痰液嗜酸性粒细胞与BAL嗜酸性粒细胞（n = 20，r = 0.45，p = 0.045）和Fe(NO)（n = 23，r = 0.42，p = 0.049）之间均存在显著相关性。Fe(NO)与BAL嗜酸性粒细胞之间的关系也很显著，相关性更强（n = 24，r = 0.54，p = 0.006）。痰液嗜酸性粒细胞百分比升高（> 2.5%）以检测BAL中嗜酸性粒细胞升高（> 1.19%）的阳性预测值（PPV）为75%；阴性预测值（NPV）为63%。痰液嗜酸性粒细胞增多且Fe(NO)值升高（> 23 ppb）的所有患者BAL中嗜酸性粒细胞均升高（PPV，100%）；这两个标志物的NPV为65%。9例无任何痰液嗜酸性粒细胞的患者中有8例上皮下嗜酸性粒细胞数量正常（< 1.2%；NPV，89%）。然而，任何痰液嗜酸性粒细胞对于上皮下嗜酸性粒细胞增多的PPV仅为36.4%。
Fe(NO)和痰液嗜酸性粒细胞与BAL嗜酸性粒细胞之间均存在中度一致性。这些标志物对于黏膜嗜酸性粒细胞增多有良好的NPV，但PPV较差。
