Li Meng, Yang Tian, He Ruiqing, Li Anqi, Dang Wenhui, Liu Xinyu, Chen Mingwei
Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2020 Nov 20;15:3025-3037. doi: 10.2147/COPD.S273422. eCollection 2020.
To evaluate the accuracy of inflammatory biomarkers in differentiating patients with asthma-COPD overlap (ACO) from those with COPD alone.
Clinical data of 134 patients with COPD and 48 patients with ACO admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to June 2019 were retrospectively analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values of fractional exhaled nitric oxide (FeNO), blood eosinophil counts (EOS), and neutrophil to lymphocyte ratio (NLR) for differentiating between ACO and COPD alone. Spearman correlation analysis was conducted to evaluate the relationships between these inflammatory biomarkers and the forced expiratory volume in one second/prediction (FEV%pred).
FeNO and EOS in the ACO patients were significantly higher than those in the COPD patients (FeNO: median 37.50 vs 24.50 ppb, < 0.001; EOS: median 0.20 vs 0.10 ×10/L, = 0.004). FeNO was positively correlated with FEV%pred (r = 0.314, = 0.030), while NLR was negatively correlated with FEV%pred (r = -0.372, = 0.009) in patients with ACO. In addition, a positive correlation between FeNO and EOS was also found in ACO, especially in patients without history of inhaled corticosteroids (ICS) use (r = 0.682, < 0.001). The optimal cut-off value of FeNO was 31.5 ppb (AUC = 0.758, 95% CI = 0.631-0.886) in patients with smoking history, with 70.0% sensitivity and 89.9% specificity for differentiating ACO from COPD. In patients without history of ICS use, the best cut-off value of FeNO was 39.5 ppb (AUC = 0.740, 95% CI = 0.610-0.870), with 58.3% sensitivity and 84.9% specificity. Among patients without history of ICS use and smoking, 27.5 ppb was optimal cut-off level for FeNO (AUC = 0.744, 95% CI = 0.579-0.908) to diagnose ACO, with 81.8% sensitivity and 60.7% specificity, and the sensitivity was improved to 91.7% when FeNO was combined with EOS.
The inflammatory biomarkers FeNO and EOS can be used as indicators for differentiating between ACO and COPD alone.
评估炎症生物标志物在区分哮喘-慢性阻塞性肺疾病重叠综合征（ACO）患者与单纯慢性阻塞性肺疾病（COPD）患者中的准确性。
回顾性分析2016年1月至2019年6月在西安交通大学第一附属医院收治的134例COPD患者和48例ACO患者的临床资料。采用受试者操作特征（ROC）曲线分析来确定呼出一氧化氮分数（FeNO）、血嗜酸性粒细胞计数（EOS）和中性粒细胞与淋巴细胞比值（NLR）区分ACO与单纯COPD的最佳截断值。进行Spearman相关性分析以评估这些炎症生物标志物与一秒用力呼气容积/预测值（FEV%pred）之间的关系。
ACO患者的FeNO和EOS显著高于COPD患者（FeNO：中位数37.50对24.50 ppb，<0.001；EOS：中位数0.20对0.10×10⁹/L，=0.004）。在ACO患者中，FeNO与FEV%pred呈正相关（r = 0.314，=0.030），而NLR与FEV%pred呈负相关（r = -0.372，=0.009）。此外，在ACO患者中，尤其是无吸入性糖皮质激素（ICS）使用史的患者中，还发现FeNO与EOS之间存在正相关（r = 0.682，<0.001）。有吸烟史患者中，FeNO的最佳截断值为31.5 ppb（AUC = 0.758，95%CI = 0.631 - 0.886），区分ACO与COPD的灵敏度为70.0%，特异度为89.9%。在无ICS使用史的患者中，FeNO的最佳截断值为39.5 ppb（AUC = 0.740，95%CI = 0.610 - 0.870），灵敏度为58.3%，特异度为84.9%。在无ICS使用史且无吸烟史的患者中，FeNO诊断ACO的最佳截断水平为27.5 ppb（AUC = 0.744，95%CI = 0.579 - 0.908），灵敏度为81.8%，特异度为60.7%，当FeNO与EOS联合使用时，灵敏度提高到91.7%。
炎症生物标志物FeNO和EOS可作为区分ACO与单纯COPD的指标。
