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目的:研究呼出气一氧化氮(FeNO)检测对哮喘-慢性阻塞性肺疾病(COPD)重叠综合征(ACOS)患者的临床意义。方法:以2014年4月-2015年11月在我院就诊的COPD患者为研究对象,根据其表型分为单纯COPD组46例和ACOS者(42例),同时选取健康体检者30例作为对照组。观察三组研究对象FeNO、诱导痰细胞计数、血清超敏C反应蛋白(hs-CRP)、血清白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平的差异,分析ACOS患者FeNO水平与诱导痰细胞计数、hs-CRP、IL-8、TNF-α的相关性。结果:三组研究对象之间性别构成、体重、身高与吸烟量无统计学差异。与单纯COPD组进行比较,ACOS组患者FeNO水平与痰嗜酸粒细胞计数明显增高或增多(P<0.05);痰细胞总数、hs-CRP、IL-8与TNF-α则没有统计学差异。与健康对照组比较,ACOS组FeNO水平、痰细胞总数、痰嗜酸粒细胞计数、hs-CRP、IL-8与TNF-α均明显增高或增多(P<0.05);单纯COPD组痰细胞总数、hs-CRP、IL-8及TNF-α均明显增多或增高,有明显统计学差异,P<0.05,而FeNO与痰嗜酸粒细胞计数则没有统计学差异。ACOS组患者FeNO与痰嗜酸粒细胞计数呈正相关,r=0.387,P<0.05;与痰细胞总数、FEV1%、FEV1/FVC%、及血清hs-CRP、IL-8、TNF-α之间的相关性均无统计学意义,r=0.264,0.286,0.301,0.238,0.203,0.226,均P>0.05。结论:ACOS患者的气道炎症与嗜酸粒细胞有一定关系。FeNO检测从一定程度反映了ACOS患者的气道炎症,能够从COPD人群中识别出ACOS患者。
Objective: To investigate the clinical significance of exhaled nitric oxide (FeNO) detection in patients with asthma - chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS). Methods: COPD patients treated in our hospital from April 2014 to November 2015 were divided into two groups: COPD group (46 cases) and ACOS group (42 cases). 30 healthy subjects were selected as the Control group. The differences of FeNO, sputum cell count, serum hs-CRP, IL-8 and TNF-αlevels in the three groups were observed. The correlation between FeNO levels and induced sputum cell counts, hs-CRP, IL-8 and TNF-α in ACOS patients was analyzed. Results: There was no significant difference in sex composition, weight, height and smoking between the three groups. Compared with simple COPD group, FeNO level and sputum eosinophil count in ACOS group were significantly increased or increased (P <0.05). There was no statistical difference in total sputum cells, hs-CRP, IL-8 and TNF-α. Compared with the healthy control group, the levels of FeNO, total sputum cells, sputum eosinophil count, hs-CRP, IL-8 and TNF-αwere significantly increased or increased in ACOS group (P <0.05) , Hs-CRP, IL-8 and TNF-α were significantly increased or increased, with significant statistical difference, P <0.05, while the FeNO and sputum eosinophil count was not statistically different. There was a positive correlation between FeNO and sputum eosinophil count in patients with ACOS (r = 0.387, P <0.05), and sputum cells, FEV1%, FEV1 / FVC%, serum hs-CRP, IL-8 and TNF- The correlation was not statistically significant, r = 0.264,0.286,0.301,0.238,0.203,0.226, all P> 0.05. Conclusion: Airway inflammation in patients with ACOS has some relationship with eosinophils. FeNO to some extent reflects the airway inflammation in patients with ACOS, ACOS patients can be identified from the COPD population.