呼出一氧化氮检测系统性硬化症间质性肺疾病的诊断价值

Diagnostic value of exhaled nitric oxide to detect interstitial lung disease in systemic sclerosis.

作者信息

Tiev K P, Coste J, Ziani M, Aubourg F, Cabane J, Dinh-Xuan A T

机构信息

Université Paris VI, Pierre et Marie Curie, Faculté de Médecine, Assistance Publique Hôpitaux de Paris, Service de Médecine Interne, Hôpital Saint-Antoine, Paris, France.

出版信息

Sarcoidosis Vasc Diffuse Lung Dis. 2009 Jul;26(1):32-8.

PMID:19960786

Abstract

BACKGROUND AND AIM

Increased alveolar concentration of nitric oxide (CA(NO)) is related to the severity of interstitial lung disease (ILD) in systemic sclerosis (SSc). However, cut-off levels of CA(NO) to rule out, or to rule in, the presence of ILD in individual patients are unknown. We aimed to assess the validity of CA(NO) for the diagnosis of ILD in SSc and to determine the thresholds of CA(NO) that can be used in clinical practice to predict the likelihood of ILD in SSc.

METHODS

Lung HRCT scan, PFTs and partitioned exhaled NO measurements were performed in 65 consecutive SSc patients. ILD was diagnosed on pulmonary HRCT according to the presence of ground glass or reticular opacities. Diagnostic performance of CANo for ILD diagnosis was assessed using ROC curves.

RESULTS

38 out of 65 SSc patients had ILD. CA(NO), at a cut-off level of 4.3 ppb, had a sensitivity and specificity for the diagnosis of ILD of 87% (95% CI: 77 to 99) and 59% (95% CI: 41 to 78), respectively. The same cut-off level of CA(NO) could detect impairment of gas exchange with a sensitivity and specificity of 78% (95% CI: 67 to 90) and 73% (95% CI: 46 to 99), respectively. Moreover, ILD could be ruled in (positive predictive value > 95%) when CA(NO) > or = 10.8 ppb, and ruled out C(ANO) values < or = 3.8 ppb (negative predictive value > 95%).

CONCLUSION

CA(NO) could be a valid non-invasive biological marker of ILD in SSc, and be of use in clinical practice.

摘要

背景与目的

系统性硬化症（SSc）患者肺泡一氧化氮浓度（CA(NO)）升高与间质性肺疾病（ILD）的严重程度相关。然而，尚不清楚在个体患者中用于排除或确诊ILD的CA(NO)临界值。我们旨在评估CA(NO)对SSc中ILD诊断的有效性，并确定可在临床实践中用于预测SSc中ILD可能性的CA(NO)阈值。

方法

对65例连续的SSc患者进行肺部高分辨率CT扫描（HRCT）、肺功能测试（PFTs）和分段呼出一氧化氮测量。根据磨玻璃影或网状阴影的存在，通过肺部HRCT诊断ILD。使用ROC曲线评估CA(NO)对ILD诊断的性能。

结果

65例SSc患者中有38例患有ILD。CA(NO)的临界值为4.3 ppb时，对ILD诊断的敏感性和特异性分别为87%（95% CI：77至99）和59%（95% CI：41至78）。相同的CA(NO)临界值可检测气体交换受损，敏感性和特异性分别为78%（95% CI：67至90）和73%（95% CI：46至99）。此外，当CA(NO)≥10.8 ppb时可确诊ILD（阳性预测值>95%），而当CA(NO)值≤3.8 ppb时可排除ILD（阴性预测值>95%）。