根据特应性状态，呼出气一氧化氮分数在持续性和慢性咳嗽中的诊断效用。

Diagnostic utility of fractional exhaled nitric oxide in prolonged and chronic cough according to atopic status.

作者信息

Asano Takamitsu, Takemura Masaya, Fukumitsu Kensuke, Takeda Norihisa, Ichikawa Hiroya, Hijikata Hisatoshi, Kanemitsu Yoshihiro, Uemura Takehiro, Takakuwa Osamu, Ohkubo Hirotsugu, Maeno Ken, Ito Yutaka, Oguri Tetsuya, Nakamura Atsushi, Niimi Akio

机构信息

Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

出版信息

Allergol Int. 2017 Apr;66(2):344-350. doi: 10.1016/j.alit.2016.08.015. Epub 2016 Sep 29.

DOI:10.1016/j.alit.2016.08.015

PMID:27693513

Abstract

BACKGROUND

Cough-variant asthma (CVA) and cough-predominant asthma (CPA) are the major causes of persistent cough in Japan. The utility of fractional exhaled nitric oxide (FeNO) measurement in the differential diagnosis of persistent cough has been reported, but the influence of atopic status, which is associated with higher FeNO levels, on the diagnostic utility of FeNO has been unknown.

METHODS

We retrospectively analyzed 105 non-smoking patients with prolonged and chronic cough that were not treated with corticosteroids and anti-leukotrienes.

RESULTS

CPA was diagnosed in 37 patients, CVA in 40, and non-asthmatic cough (NAC) in 28. FeNO levels were significantly higher in the CPA [35.8 (7.0-317.9) ppb] and CVA [24.9 (3.1-156.0) ppb] groups than in the NAC group [18.2 (6.9-49.0) ppb] (p < 0.01 by Kruskal-Wallis test). The optimal cut-off for distinguishing asthmatic cough (AC; CPA and CVA) from NAC was 29.2 ppb [area under the curve (AUC) 0.74, p < 0.01]. Ninety-one percent of subjects with FeNO levels ≥29.2 ppb had AC. Meanwhile, 40% of AC patients had FeNO levels <29.2 ppb. Stratified cut-off levels were 31.1 ppb (AUC 0.83) in atopic subjects vs. 19.9 ppb (AUC 0.65) in non-atopic subjects (p = 0.03 for AUC).

CONCLUSIONS

Although high FeNO levels suggested the existence of AC, lower FeNO levels had limited diagnostic significance. Atopic status affects the utility of FeNO levels in the differential diagnosis of prolonged and chronic cough.

摘要

背景

咳嗽变异性哮喘（CVA）和以咳嗽为主的哮喘（CPA）是日本持续性咳嗽的主要原因。已有报道指出，呼出一氧化氮分数（FeNO）测量在持续性咳嗽的鉴别诊断中具有一定作用，但与较高FeNO水平相关的特应性状态对FeNO诊断效用的影响尚不清楚。

方法

我们回顾性分析了105例未接受皮质类固醇和抗白三烯治疗的非吸烟患者，这些患者均有长期慢性咳嗽症状。

结果

37例患者被诊断为CPA，40例为CVA，28例为非哮喘性咳嗽（NAC）。CPA组[35.8（7.0 - 317.9）ppb]和CVA组[24.9（3.1 - 156.0）ppb]的FeNO水平显著高于NAC组[18.2（6.9 - 49.0）ppb]（Kruskal - Wallis检验，p < 0.01）。区分哮喘性咳嗽（AC；CPA和CVA）与NAC的最佳截断值为29.2 ppb[曲线下面积（AUC）0.74，p < 0.01]。FeNO水平≥29.2 ppb的受试者中有91%患有AC。同时，40%的AC患者FeNO水平<29.2 ppb。特应性受试者的分层截断值为31.1 ppb（AUC 0.83），非特应性受试者为19.9 ppb（AUC 0.65）（AUC的p值 = 0.03）。