Fukuhara Masanori, Tsuburai Takahiro, Nakamura Yuto, Tomita Yasuhiro, Hamada Yuto, Watai Kentaro, Hayashi Hiroaki, Kamide Yousuke, Sekiya Kiyoshi, Mitsui Chihiro, Fukutomi Yuma, Mori Akio, Taniguchi Masami
Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital.
Arerugi. 2017;66(1):42-49. doi: 10.15036/arerugi.66.42.
The bronchial hyperresponsiveness (BHR) test is useful to diagnose or evaluate effect of therapy in asthmatics, but invasive. On the other hands, the fraction of exhaled nitric oxide (FENO) is a useful noninvasive marker of eosinophilic airway inflammation in asthmatics. And also, the forced oscillation technique (FOT) is a noninvasive method that is used to measure respiratory mechanics, including respiratory resistance and reactance at multiple frequencies.
To evaluate the complementary roles of FENO and FOT to predict bronchial hyperresponsiveness in adult stable asthmatic patients taking inhaled corticosteroids.
From our outpatient clinic, we recruited 115 stable asthmatics that were being treated with inhaled corticosteroids at the time of the study. For each subject, we measured FENO by using an offline methods (CEIS' method); and we measured resistance at 5Hz (R5), resistance at 20Hz (R20), R5-R20, reactance at 5Hz (X5), frequency of resonance (Fres), and low-frequency reactance area (ALX), by using a MostGraph FOT machine. We also used spirometry to test BHR to acetylcholine (PC).
LogPC was significantly correlated with FENO, R5, R20, R5-R20 and %FEV. The ROC curve decided that the cutoff point of FENO was 37.8ppb (AUC=0.647, sensitivity 83.3%, specificity 55.6%, p=0.007) and that of R5 was 3.03cmHO/L/S (AUC=0.684, sensitivity 72.2%, specificity 52.8%, p=0.001) and that of R20 was 2.77cmHO/L/S (AUC=0.684, sensitivity 74.5%, specificity 59.4%, p=0.001). When R5 was >3.03 and FENO was >37.8ppb, 25 of 38 subjects (65.7%) had bronchial hyperresponsiveness. If R5 was <3.03 and FENO was <37.8 ppb, only 5 of 29 (17.2%) subjects had. When R20 was >2.77 and FENO was >37.8ppb, 29 of 43 subjects (67.4%) had bronchial hyperresponsiveness. If R20 was <3.03 and FENO was <37.8ppb, only 2 of 18 (11.1%) subjects had.
Combining R5 or R20 and FENO can predict the level of bronchial hyperresponsiveness in adult stable asthmatics.
支气管高反应性（BHR）测试对于诊断或评估哮喘患者的治疗效果很有用，但具有侵入性。另一方面，呼出一氧化氮分数（FENO）是哮喘患者嗜酸性气道炎症的一种有用的非侵入性标志物。此外，强迫振荡技术（FOT）是一种用于测量呼吸力学的非侵入性方法，包括多个频率下的呼吸阻力和电抗。
评估FENO和FOT在预测接受吸入性糖皮质激素治疗的成年稳定哮喘患者支气管高反应性方面的互补作用。
从我们的门诊诊所，我们招募了115名在研究时正在接受吸入性糖皮质激素治疗的稳定哮喘患者。对于每个受试者，我们使用离线方法（CEIS法）测量FENO；并使用MostGraph FOT机器测量5Hz时的阻力（R5）、20Hz时的阻力（R20）、R5-R20、5Hz时的电抗（X5）、共振频率（Fres）和低频电抗面积（ALX）。我们还使用肺量计测试对乙酰胆碱（PC）的BHR。
LogPC与FENO、R5、R20、R5-R20和%FEV显著相关。ROC曲线确定FENO的截断点为37.8ppb（AUC=0.647，敏感性83.3%，特异性55.6%，p=0.007），R5的截断点为3.03cmH₂O/L/s（AUC=0.684，敏感性72.2%，特异性52.8%，p=0.001），R20的截断点为2.77cmH₂O/L/s（AUC=0.684，敏感性74.5%，特异性59.4%，p=0.001）。当R5>3.03且FENO>37.8ppb时，38名受试者中有25名（65.7%）有支气管高反应性。如果R5<3.03且FENO<37.8ppb，29名受试者中只有5名（17.2%）有。当R20>2.77且FENO>37.8ppb时，43名受试者中有29名（67.4%）有支气管高反应性。如果R20<3.03且FENO<37.8ppb，18名受试者中只有2名（11.1%）有。
结合R5或R20与FENO可以预测成年稳定哮喘患者的支气管高反应性水平。
