Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China.
Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing, PR China.
COPD. 2020 Apr;17(2):121-127. doi: 10.1080/15412555.2019.1704231. Epub 2020 Mar 2.
The value of fractional exhaled nitric oxide (FeNO) in patients with chronic obstructive pulmonary disease (COPD) remains unclear. We aimed to assess whether FeNO is a more valuable biomarker than blood eosinophil count for identifying clinical characteristics of COPD. Stable COPD patients ( = 390) were included and stratified by FeNO and blood eosinophil counts at recruitment. The demographic characteristics, lung functions, St George Respiratory Questionnaire (SGRQ), serum inhaled allergen-specific IgE and the exacerbations in the preceding 12 months were compared. Risk factors for moderate or severe exacerbation in the preceding 12 months were examined by binary regression analysis. The cross-sectional study showed that 167 patients had high level of FeNO (≥25 ppb) and 223 in low level (<25 ppb), while 138 patients had high blood eosinophil count (≥200 cells/μL) and 252 had low (<200 cells/μL). Compared with the high FeNO group, there were higher proportion of patients with GOLD III-IV, higher SGRQ scores, more exacerbations in the preceding 12 months, and with lower positive proportion of sIgE in the low FeNO group ( < 0.05 for all). However, these phenomena above were not associated with blood eosinophil count. Finally, high FeNO level was associated with a lower moderate or severe exacerbation in preceding 12 months (RR: 0.541 [95%CI 0.319-0.917], = 0.023). In stable COPD patients, FeNO, but not blood eosinophil count was associated with the COPD severity and allergic airway inflammation. However, the role of FeNO in guiding personalized treatment of COPD patients need to be further investigated.
呼出气一氧化氮（FeNO）在慢性阻塞性肺疾病（COPD）患者中的价值尚不清楚。我们旨在评估 FeNO 是否比血嗜酸性粒细胞计数更能识别 COPD 的临床特征。纳入稳定期 COPD 患者（n=390），根据招募时的 FeNO 和血嗜酸性粒细胞计数进行分层。比较了两组的人口统计学特征、肺功能、圣乔治呼吸问卷（SGRQ）评分、血清吸入性过敏原特异性 IgE 以及前 12 个月的加重情况。采用二项回归分析检查前 12 个月中中重度加重的危险因素。这项横断面研究显示，167 例患者 FeNO 水平较高（≥25 ppb），223 例患者 FeNO 水平较低（<25 ppb），138 例患者血嗜酸性粒细胞计数较高（≥200 细胞/μL），252 例患者血嗜酸性粒细胞计数较低（<200 细胞/μL）。与高 FeNO 组相比，低 FeNO 组患者中 GOLD III-IV 期比例更高、SGRQ 评分更高、前 12 个月加重次数更多、sIgE 阳性率更低（均<0.05）。然而，这些现象与血嗜酸性粒细胞计数无关。最后，高 FeNO 水平与前 12 个月中中重度加重的风险降低相关（RR：0.541 [95%CI 0.319-0.917]，=0.023）。在稳定期 COPD 患者中，FeNO 而非血嗜酸性粒细胞计数与 COPD 严重程度和过敏性气道炎症相关。然而，FeNO 在指导 COPD 患者个体化治疗中的作用还需要进一步研究。
