呼出气一氧化氮分数在诊断伴有鼻息肉的哮喘型 2 型慢性鼻-鼻窦炎中的作用。

The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps.

机构信息

Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.

Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.

出版信息

Am J Rhinol Allergy. 2023 Sep;37(5):524-530. doi: 10.1177/19458924231173205. Epub 2023 May 9.

DOI:10.1177/19458924231173205

PMID:37160729

Abstract

BACKGROUND

Fractional exhaled nitric oxide (FeNO) is useful in the management of asthma and predicting the efficacy of standard corticosteroids and biologics. However, the diagnostic value of FeNO in asthmatic chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear.

OBJECTIVE

We assessed FeNO levels in patients with CRSwNP and evaluated the diagnostic value of FeNO for screening type 2 CRSwNP (T2-CRSwNP) with asthma.

METHODS

We enrolled 94 patients who were diagnosed with CRSwNP and underwent functional endoscopic sinus surgery. FeNO levels, the blood eosinophil percentage, total IgE, spirometry tests (FEV1/FVC), Lund-Mackay CT score, and percentage of patients with comorbid asthma were compared among CRSwNP subgroups. Spearman rank correlation test was used to assess the degree of association between variables. ROC curve analysis was conducted to evaluate the diagnostic capability to differentiate T2-CRSwNP based on clinical and histological classifications.

RESULTS

FeNO levels and the blood eosinophil percentage were significantly higher in patients with T2-CRSwNP(h) based on histological data ( < .05). FeNO was correlated with the blood eosinophil percentage ( = 0.420, < .001) and FEV1/FVC ( = -0.324, = .001). A FeNO level of 27 ppb had a good ability to discriminate patients with asthmatic T2-CRSwNP(h) (AUC = 0.848; 95% CI = 0.7602-0.9361; sensitivity = 90.9%; specificity = 63.9%). The optimal cutoff values for FeNO and the blood eosinophil percentage for diagnosing asthmatic T2-CRSwNP(h) were 68 ppb and 5.6% (sensitivity = 95.5%; specificity = 86.1%; AUC = 0.931; 95% CI = 0.8832-0.9791). In the diagnosis of severe T2-CRSwNP(c) based on clinical data, a FeNO level of 36 ppb showed the highest AUC (0.816; 95% CI = 0.7173-0.914; sensitivity = 72.7%; specificity = 79.2%).

CONCLUSION

FeNO is a useful marker for screening asthmatic T2-CRSwNP even prior to biopsy or asthma evaluation and may assist in selecting a proper treatment.

摘要

背景

呼出气一氧化氮分数（FeNO）可用于哮喘的管理，并预测标准皮质类固醇和生物制剂的疗效。然而，FeNO 在伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）中的诊断价值尚不清楚。

目的

我们评估了伴有鼻息肉的 CRSwNP 患者的 FeNO 水平，并评估了 FeNO 对筛查伴有哮喘的 2 型 CRSwNP（T2-CRSwNP）的诊断价值。

方法

我们纳入了 94 名被诊断为 CRSwNP 并接受功能性内镜鼻窦手术的患者。比较了 CRSwNP 亚组之间的 FeNO 水平、血嗜酸性粒细胞百分比、总 IgE、肺功能检查（FEV1/FVC）、Lund-Mackay CT 评分和伴有哮喘的患者比例。Spearman 秩相关检验用于评估变量之间的关联程度。ROC 曲线分析用于评估基于临床和组织学分类的 T2-CRSwNP 鉴别诊断的诊断能力。

结果

根据组织学数据，T2-CRSwNP（h）患者的 FeNO 水平和血嗜酸性粒细胞百分比明显更高（ < .05）。FeNO 与血嗜酸性粒细胞百分比（ = 0.420， < .001）和 FEV1/FVC（ = -0.324， = .001）相关。FeNO 水平为 27 ppb 时，能够很好地区分伴有哮喘的 T2-CRSwNP（h）患者（AUC = 0.848；95%CI = 0.7602-0.9361；敏感性 = 90.9%；特异性 = 63.9%）。用于诊断伴有哮喘的 T2-CRSwNP（h）的 FeNO 和血嗜酸性粒细胞百分比的最佳截断值分别为 68 ppb 和 5.6%（敏感性 = 95.5%；特异性 = 86.1%；AUC = 0.931；95%CI = 0.8832-0.9791）。在基于临床数据诊断重度 T2-CRSwNP（c）时，FeNO 水平为 36 ppb 时 AUC 最高（0.816；95%CI = 0.7173-0.914；敏感性 = 72.7%；特异性 = 79.2%）。