单次呼出一氧化氮测量对哮喘儿童能说明什么？

What does a single exhaled nitric oxide measurement tell us in asthmatic children?

作者信息

Mahut Bruno, Peiffer Claudine, Thibaudon Michel, Chevalier-Bidaud Brigitte, Defrance-Hutinet Marie-France, Trinquart Ludovic, Delclaux Christophe

机构信息

Cabinet La Berma, Antony, France.

出版信息

J Asthma. 2009 Oct;46(8):810-4.

PMID:19863285

Abstract

BACKGROUND

Due to the multiple factors affecting exhaled nitric oxide (NO) value, physicians are often puzzled by the result of a single measurement in asthmatic patients.

OBJECTIVE

The aim of this prospective transversal study was to evaluate the relative contributions to exhaled NO fraction (FE(NO)) of the commonly considered major NO determinants, i.e., recent symptoms (upper and lower respiratory tract), atopy (prick skin tests and degree of allergic exposure), and treatment (dose of inhaled corticosteroid [ICS]) to know what information gives a single measure.

METHODS

FE(NO) at 50 mL/s expiratory flow was measured in 199 asthmatic children (141 boys, age: 11.2 years +/- 2.5 years). The allergic risk due to pollen exposure (ARPE index) was independently evaluated by the "Réseau National de Surveillance Aérobiologique."

RESULTS

A multivariate analysis of FE(NO) as dependent variable showed that explanatory variables explained 23% of total FE(NO) variance (symptoms > atopy > ICS). In the children without recent symptoms (n = 118), a FE(NO) > 23 ppb predicted atopy (sensitivity 47%, specificity 85%, p = 0.0006). Multiple regression only showed a trend to significance between FE(NO) and the dose of ICS (p = 0.057, r = - 0.19). Incidentally, despite similar dose of ICS, children under fluticasone (mean +/- SD, 259 +/- 149 microg/day) had lower FE(NO) than those under budesonide (299 +/- 195 microg/day) (median [interquartile], 21 ppb [14-42], n = 55 versus 35 ppb [19-47], n = 104; p = 0.007), which may be due to a higher potency of fluticasone. A relationship between FE(NO) and ARPE index was significant in children with exclusive seasonal sensitisation (n = 31, r = 0.48, p = 0.008).

CONCLUSION

Common exhaled NO determinants weakly explain a single value of FE(NO), which only can confidently predict atopy.

摘要

背景

由于多种因素影响呼出一氧化氮（NO）值，医生常常对哮喘患者单次测量的结果感到困惑。

目的

这项前瞻性横断面研究的目的是评估常见的主要NO决定因素，即近期症状（上、下呼吸道）、特应性（皮肤点刺试验和过敏暴露程度）以及治疗（吸入性糖皮质激素[ICS]剂量）对呼出NO分数（FE(NO)）的相对贡献，以了解单次测量能提供哪些信息。

方法

对199名哮喘儿童（141名男孩，年龄：11.2岁±2.5岁）进行呼气流量为50 mL/s时的FE(NO)测量。通过“全国空气生物学监测网络”独立评估花粉暴露引起的过敏风险（ARPE指数）。

结果

以FE(NO)为因变量的多变量分析表明，解释变量解释了FE(NO)总方差的23%（症状>特应性>ICS）。在近期无症状的儿童（n = 118）中，FE(NO)>23 ppb可预测特应性（敏感性47%，特异性85%，p = 0.0006）。多元回归仅显示FE(NO)与ICS剂量之间有显著趋势（p = 0.057，r = - 0.19）。顺便提一下，尽管ICS剂量相似，但使用氟替卡松的儿童（平均±标准差，259±149 μg/天）的FE(NO)低于使用布地奈德的儿童（299±195 μg/天）（中位数[四分位间距]，21 ppb[14 - 42]，n = 55对35 ppb[19 - 47]，n = 104；p = 0.007），这可能是由于氟替卡松的效力更高。在仅季节性致敏的儿童（n = 31）中，FE(NO)与ARPE指数之间存在显著关系（r = 0.48，p = 0.008）。