Department of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
J Crohns Colitis. 2013 Sep;7(8):644-8. doi: 10.1016/j.crohns.2012.09.021. Epub 2012 Oct 18.
Active inflammatory bowel disease (IBD) is associated with increased activity of inducible nitric oxide synthase (iNOS), which increases both mucosal and plasma nitric oxide (NO) levels. Increased fractional exhaled nitric oxide (FeNO) levels have been described in patients with IBD. Currently, hand-held FeNO measurement devices are available, enabling a fast in-office analysis of this non-invasive disease activity marker. In this pilot study, we investigated the utility of in-office FENO measurements in patients with Crohn's disease (CD).
Fifty CD patients and 25 healthy controls (HC) were included, all of whom were free of atopic or pulmonary disorders and respiratory symptoms at the time of inclusion. The Crohn's disease activity index (CDAI) was calculated, and the inflammatory parameters and fecal calprotectin levels were assessed. FeNO was measured with a hand-held device.
A significant increase in FeNO (median, [interquartile range]) was observed in steroid-free CD patients with clinically active disease (CDAI>150; 22 [8] ppb) compared with CD patients in clinical remission (CDAI<150; 11 [6] ppb; P<0.001) and HC's (17 [9] ppb; P<0.05). Active CD patients treated with corticosteroids had significantly lower FeNO compared with active CD patients without steroids (12 [10] ppb vs 25 [19] ppb; P<0.05). FeNO displayed a strong correlation with the CDAI (R=0.68; P<0.001). Fair correlations were found between FeNO and several systemic inflammatory markers, but no significant correlation was found with fecal calprotectin.
This pilot study suggests that hand-held FeNO measurements could be an attractive non-invasive indicator of systemic inflammation in Crohn's disease.
活性炎症性肠病（IBD）与诱导型一氧化氮合酶（iNOS）的活性增加有关，这会增加黏膜和血浆中的一氧化氮（NO）水平。IBD 患者的呼出气中一氧化氮分数（FeNO）水平升高已有描述。目前，手持式 FeNO 测量设备已经问世，能够快速对这种非侵入性疾病活动标志物进行现场分析。在这项初步研究中，我们研究了现场 FeNO 测量在克罗恩病（CD）患者中的应用价值。
共纳入 50 例 CD 患者和 25 例健康对照者（HC），所有患者在纳入时均无特应性或肺部疾病和呼吸道症状。计算克罗恩病活动指数（CDAI），评估炎症参数和粪便钙卫蛋白水平。使用手持式设备测量 FeNO。
与处于临床缓解期（CDAI<150）的 CD 患者（11 [6] ppb）和 HC（17 [9] ppb）相比，无皮质类固醇治疗且疾病处于临床活动期（CDAI>150）的 CD 患者（22 [8] ppb）的 FeNO 明显升高（P<0.001）。接受皮质类固醇治疗的活动期 CD 患者的 FeNO 明显低于无类固醇治疗的活动期 CD 患者（12 [10] ppb 比 25 [19] ppb；P<0.05）。FeNO 与 CDAI 呈强相关（R=0.68；P<0.001）。FeNO 与多种全身炎症标志物呈中度相关，但与粪便钙卫蛋白无显著相关性。
这项初步研究表明，手持式 FeNO 测量可能是克罗恩病全身炎症的一种有吸引力的非侵入性指标。
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