Brindicci Caterina, Ito Kazuhiro, Barnes Peter J, Kharitonov Sergei A
Section of Airway Disease, National Heart and Lung Institute, Imperial College, Dovehouse Street, London, UK.
Chest. 2007 May;131(5):1353-62. doi: 10.1378/chest.06-2531.
The majority of asthmatic patients achieve control of their illness; others do not. It is therefore crucial to validate/develop strategies that help the clinician monitor the disease, improving the response to treatment.
We have quantified the inflammation in central and peripheral airways by measuring exhaled nitric oxide (NO) at multiple exhalation flows in 56 asthmatics at different levels of severity (mild, n = 10; moderate stable, n = 17; moderate during exacerbation, n = 11; severe, n = 18, 7 of whom were receiving oral corticosteroids) and 18 healthy control subjects. The reproducibility of the measurement was also assessed.
Bronchial NO (Jno) in patients with mild asthma (2,363 +/- 330 pL/s) [mean +/- SD] was higher than in patients with moderate stable asthma (1,300 +/- 59 pL/s, p < 0.0005), in patients with severe asthma receiving inhaled corticosteroids (ICS) [1,015 +/- 67 pL/s, p < 0.0005], and healthy control subjects (721 +/- 22 pL/s, p < 0.0001). There were no differences between Jno in patients with mild asthma compared to patients with severe asthma receiving ICS and oral corticosteroids (2,225 +/- 246 pL/s). Patients with exacerbations showed a higher Jno (3,475 +/- 368.9 pL/s, p < 0.05) compared to the other groups. Alveolar NO was higher in patients with severe asthma receiving oral corticosteroids (3.0 +/- 0.1 parts per billion [ppb], p < 0.0001) than in the other groups but was not significantly higher than in patients with moderate asthma during exacerbation (2.8 +/- 0.3 ppb). No differences were seen in NO diffusion levels between the different asthma groups. All the measurements were highly reproducible and free of day-to-day and diurnal variations.
Differential flow analysis of exhaled NO provides additional information about the site of inflammation in asthma and may be useful in assessing the response of peripheral inflammation to therapy.
大多数哮喘患者能够控制病情；但也有部分患者不能。因此，验证/制定有助于临床医生监测疾病、改善治疗反应的策略至关重要。
我们通过在不同呼气流量下测量56例不同严重程度（轻度，n = 10；中度稳定，n = 17；中度发作期，n = 11；重度，n = 18，其中7例接受口服糖皮质激素治疗）的哮喘患者以及18名健康对照者呼出的一氧化氮（NO），对中央和外周气道的炎症进行了量化。还评估了测量的可重复性。
轻度哮喘患者的支气管NO（Jno）（2,363 ± 330 pL/s）[均值 ± 标准差]高于中度稳定哮喘患者（1,300 ± 59 pL/s，p < 0.0005）、接受吸入糖皮质激素（ICS）治疗的重度哮喘患者（1,015 ± 67 pL/s，p < 0.0005）以及健康对照者（721 ± 22 pL/s，p < 0.0001）。轻度哮喘患者与接受ICS和口服糖皮质激素治疗的重度哮喘患者的Jno（2,225 ± 246 pL/s）之间无差异。与其他组相比，发作期患者的Jno更高（3,475 ± 368.9 pL/s，p < 0.05）。接受口服糖皮质激素治疗的重度哮喘患者的肺泡NO（3.0 ± 0.1十亿分之一[ppb]，p < 0.0001）高于其他组，但与中度发作期哮喘患者（2.8 ± 0.3 ppb）相比无显著升高。不同哮喘组之间的NO扩散水平无差异。所有测量均具有高度可重复性，且无日常和昼夜变化。
呼出NO的差分流量分析提供了有关哮喘炎症部位的额外信息，可能有助于评估外周炎症对治疗的反应。
