Bao Wuping, Zhang Xue, Yin Junfeng, Han Lei, Huang Zhixuan, Bao Luhong, Lv Chengjian, Hao Huijuan, Xue Yishu, Zhou Xin, Zhang Min
Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
School of Mathematical Sciences, Tongji University, Shanghai, People's Republic of China.
J Asthma Allergy. 2021 Apr 21;14:415-426. doi: 10.2147/JAA.S295345. eCollection 2021.
Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky, and not readily available in all clinical settings.
A cross-sectional study was performed in 692 patients with FEV≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness.
Compared with subjects negative for AHR (n=522), subjects positive for AHR (n=170) showed increased FENO values, peripheral eosinophils (EOS), and R5-R20; decreased FEV, FEV/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (≤.001 for all). Small-airway dysfunction was identified in 104 AHR patients (61.17%), and 132 AHR patients (25.29%) (<0.001). The areas under the curve (AUCs) of variables used singly for an AHR diagnosis were lower than 0.77. Using joint models of FEF, FEF, or FEF with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs ( <0.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (<0.001 for all). In subjects with chest tightness, the combination of FEF or FEF with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively ( <0.001 for all versus the univariate AUCs).
FENO combined with FEF and FEF predict AHR in patients with normal FEV. FEF, FEF, or FEF together with EOS also can potentially suggest asthma in patients with chest tightness.
有提示哮喘的各种症状但一秒用力呼气容积（FEV）正常的患者，若不进行支气管激发试验往往无法确诊，但该试验费用高昂、耗时、有风险，且并非在所有临床环境中都能轻易开展。
对692例FEV≥预测值80%；中性粒细胞和胸部高分辨率计算机断层扫描正常；且有反复发作的呼吸困难、咳嗽、喘息和胸闷的患者进行了一项横断面研究。
与气道高反应性（AHR）阴性的受试者（n = 522）相比，AHR阳性的受试者（n = 170）显示呼出一氧化氮（FENO）值、外周嗜酸性粒细胞（EOS）和R5 - R20升高；FEV、FEV/用力肺活量（FVC）和用力呼气流量（FEFs）降低（均P≤0.001）。104例AHR患者（61.17%）存在小气道功能障碍，132例AHR患者（25.29%）（P<0.001）。单独用于AHR诊断的变量的曲线下面积（AUC）低于0.77。使用FEF、FEF或FEF与FENO的联合模型可将AUC分别提高到0.845、0.824和0.844，显著高于单变量AUC（均P<0.001）。报告有胸闷的患者（n = 75）的FEFs低于无胸闷的患者（均P<0.001）。在有胸闷的受试者中，FEF或FEF与EOS的联合也使AUC大幅增加，分别达到0.815和0.816（与单变量AUC相比均P<0.001）。
FENO与FEF和FEF联合可预测FEV正常患者的AHR。FEF、FEF或FEF与EOS联合也可能提示有胸闷患者的哮喘。
