Liu Chengyao, Zheng Kaili, Liu Xiaofang, Zheng Ming, Liu Zhongyan, Wang Xiangdong, Zhang Luo
Department of Otolaryngology Head and Neck Surgery and Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
J Allergy Clin Immunol Pract. 2020 May;8(5):1574-1581.e4. doi: 10.1016/j.jaip.2019.12.017. Epub 2019 Dec 28.
Nasal nitric oxide (nNO) has been evaluated in patients with chronic rhinosinusitis with and without nasal polyps. However, nNO levels in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR) have shown conflicting results in previous studies.
To evaluate the value of nNO in diagnosing AR and NAR and the impact of absence or presence of sinus inflammation (SI).
A total of 173 consecutive patients scanned with high-resolution computed tomography (CT) and 46 normal controls (NCs) were included in our study. Patients were evaluated according to their medical history, nasal symptoms, endoscopic examinations, and skin prick test results. On the basis of CT scans (Lund-Mackay score >2), all patients were subgrouped as AR with SI (ARwSI) and AR without SI (ARsSI), or NAR with SI (NARwSI) and NAR without SI (NARsSI). nNO levels were measured with the NIOX, and eosinophils in nasal smears were evaluated simultaneously. Receiver-operating characteristic analysis was performed for differential diagnosis of AR, NAR, and subgroups.
Ninety-four patients were diagnosed with AR and 79 patients with NAR. The levels of nNO were significantly higher in patients with AR and in NCs compared with patients with NAR (939 ± 335 in AR and 813 ± 272 in NCs vs 670 ± 188 in NAR; P < .001 for both), and significantly higher in patients with AR compared with NCs (P < .05). On the basis of sinus CT scans, 49% patients with AR (46 of 94) were defined as ARwSI and 51% patients with NAR (40 of 79) were defined as NARwSI. Patients with ARsSI showed the highest nNO levels (1180 ± 289) compared with other subgroups (P < .001), and patients with NARwSI showed the lowest nNO levels (522 ± 120) compared with other subgroups (P < .001). nNO could be used to discriminate AR, NAR, and subgroups with acceptable sensitivity and specificity. Moreover, patients with nasal smear eosinophilia had lower nNO levels than did patients with NAR (P < .05).
nNO levels are different between patients with ARwSI/ARsSI and NARwSI/NARsSI, and may be used to discriminate these phenotypes.
已对患有和未患有鼻息肉的慢性鼻-鼻窦炎患者的鼻一氧化氮（nNO）进行了评估。然而，先前研究中变应性鼻炎（AR）和非变应性鼻炎（NAR）患者的nNO水平结果相互矛盾。
评估nNO在诊断AR和NAR中的价值以及鼻窦炎症（SI）存在与否的影响。
本研究纳入了173例连续接受高分辨率计算机断层扫描（CT）的患者和46例正常对照（NC）。根据患者的病史、鼻部症状、内镜检查和皮肤点刺试验结果进行评估。基于CT扫描（Lund-Mackay评分>2），所有患者被分为伴有SI的AR（ARwSI）和不伴有SI的AR（ARsSI），或伴有SI的NAR（NARwSI）和不伴有SI的NAR（NARsSI）。使用NIOX测量nNO水平，并同时评估鼻涂片嗜酸性粒细胞。进行接受者操作特征分析以对AR、NAR及其亚组进行鉴别诊断。
94例患者被诊断为AR，79例患者被诊断为NAR。与NAR患者相比，AR患者和NC的nNO水平显著更高（AR为939±335，NC为813±272，NAR为670±188；两者P均<.001），且AR患者的nNO水平显著高于NC（P<.05）。基于鼻窦CT扫描，49%的AR患者（94例中的46例）被定义为ARwSI，51%的NAR患者（79例中的40例）被定义为NARwSI。与其他亚组相比，ARsSI患者的nNO水平最高（1180±289）（P<.001），与其他亚组相比，NARwSI患者的nNO水平最低（522±120）（P<.001）。nNO可用于以可接受的敏感性和特异性鉴别AR、NAR及其亚组。此外，鼻涂片嗜酸性粒细胞增多的患者的nNO水平低于NAR患者（P<.05）。
ARwSI/ARsSI患者与NARwSI/NARsSI患者的nNO水平不同，且可用于鉴别这些表型。
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