吸烟对哮喘患者FeNO和肺功能的影响
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摘要
目的探讨吸烟对哮喘患者FeNO和肺功能的影响。方法选取2017年1月至2018年5月于承德医学院附属医院确诊的哮喘患者217例,其中吸烟患者81例(吸烟组),不吸烟患者74例(不吸烟组),已戒烟患者62例(已戒烟组),比较3组间FeNO值、第1秒用力呼气容积占预计值百分比(FEV_1%)、第1秒用力呼气容积/用力肺活量(FEV_1/FVC)、最大呼气流量(MEF)25-75/预计值、和哮喘控制测试(ACT)评分,探讨FeNO与肺功能各指标、ACT评分、吸烟指数、嗜酸性粒细胞百分比(EO%)的相关性。结果吸烟患者FEV_1/FVC较不吸烟组低,差异有统计学意义(P<0.05)。吸烟患者MEF25-75/预计值较不吸烟及已戒烟患者低,差异有统计学意义(P<0.05)。吸烟组FeNO值较不吸烟组、已戒烟组低,差异有统计学意义(P<0.05)。哮喘患者FeNO水平与血EO%呈正相关(r=0.482,P=0.041),与FEV_1/FVC、MEF25～75/预计值、吸烟指数呈负相关性(r=-0.237、-0.384、-0.526,P=0.022、0.003、0.038),差异有统计学意义(P<0.05)。结论吸烟可以降低哮喘患者小气道功能指标与FeNO值,使用单一的FeNO方法评估吸烟患者的气道炎症,有可能会低估其气道炎症水平。FeNO水平更能反映哮喘患者嗜酸性气道炎症,能在一定程度上反映小气道功能障碍,尤其在不吸烟的哮喘患者评估价值更高,且FeNO值越高,小气道阻力越高。
Objective To investigate the effect of smoking on FeNO and lung function in asthmatic patients. Methods A total of 217 asthma patients diagnosed in the Affiliated Hospital of Chengde Medical College from January 2017 to May 2018 were selected, including 81 smoking patients(the smoking group), 74 non-smoking patients(the non-smoking group), and 62 patients who had quit smoking(the smoking cessation group). Their FeNO value, forced expiratory volume in the first second/predicted value(FEV_1%), forced expiratory volume in the first second/forced vital capacity(FEV_1/FVC), maximal expiratory flow(MEF)25-75/predicted value, and ACT score were compared between the two groups to explore the correlation between FeNO and lung function indicators, ACT score, smoking index, and percentage of eosinophils(EO%). Results FEV_1/FVC in the smoking patients group was lower than that of the non-smoking group(P<0.05). MEF25-75/predicted value of the smoking patients group was lower than that of the non-smokers group and the smoking cessation group(P<0.05). The FeNO value of the smoking group was lower than that of the non-smoking group and the smoking cessation group(P<0.05). The level of FeNO in asthma patients was positively correlated with blood EO%(r=0.482, P=0.041), and negatively correlated with FEV_1/FVC, MEF25-75/predided value, and smoking index(r=-0.237,-0.384,-0.526, P=0.022, 0.003, 0.038)(P<0.05). Conclusion Smoking can reduce FeNO value in asthmatic patients, and it may underestimate the level of airway inflammation if only rely on FeNO. The level of FeNO can better reflect eosinophilic airway inflammation in asthmatic patients and small airway dysfunction to a certain extent, especially in patients with non-smoking patients. The higher the FeNO value is, the higher the small airway resistance has.
Objective To investigate the effect of smoking on FeNO and lung function in asthmatic patients. Methods A total of 217 asthma patients diagnosed in the Affiliated Hospital of Chengde Medical College from January 2017 to May 2018 were selected, including 81 smoking patients(the smoking group), 74 non-smoking patients(the non-smoking group), and 62 patients who had quit smoking(the smoking cessation group). Their FeNO value, forced expiratory volume in the first second/predicted value(FEV_1%), forced expiratory volume in the first second/forced vital capacity(FEV_1/FVC), maximal expiratory flow(MEF)25-75/predicted value, and ACT score were compared between the two groups to explore the correlation between FeNO and lung function indicators, ACT score, smoking index, and percentage of eosinophils(EO%). Results FEV_1/FVC in the smoking patients group was lower than that of the non-smoking group(P<0.05). MEF25-75/predicted value of the smoking patients group was lower than that of the non-smokers group and the smoking cessation group(P<0.05). The FeNO value of the smoking group was lower than that of the non-smoking group and the smoking cessation group(P<0.05). The level of FeNO in asthma patients was positively correlated with blood EO%(r=0.482, P=0.041), and negatively correlated with FEV_1/FVC, MEF25-75/predided value, and smoking index(r=-0.237,-0.384,-0.526, P=0.022, 0.003, 0.038)(P<0.05). Conclusion Smoking can reduce FeNO value in asthmatic patients, and it may underestimate the level of airway inflammation if only rely on FeNO. The level of FeNO can better reflect eosinophilic airway inflammation in asthmatic patients and small airway dysfunction to a certain extent, especially in patients with non-smoking patients. The higher the FeNO value is, the higher the small airway resistance has.
引文
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[11]杨琤瑜,杨冬,叶伶,等.吸烟对成人哮喘控制及气道炎性反应的影响[J].中国临床医学,2013,20(2):138-140.
[2]VAN BERKEL A C,DEN DEKKER H T,JADDOE V W,et al.Mode of delivery and childhood fractional exhaled nitric oxide,interrupter resistance and asthma:the Generation R study[J].Pediatr Allergy Immunol,2015,26(4):330-336.
[3]YUNE S,LEE J Y,CHOI D C,et al.Fractional exhaled nitric oxide:comparison between portable devices and correlation with sputum eosinophils[J].Allergy Asthma Immunol Res,2015,7(4):404-408.
[4]LUDVIKSDOTTIR D,DIAMANT Z,ALVING K,et al.Clinical aspects of using exhaled NO in asthma diagnosis and management[J].Clin Respir J,2012,6(4):193-207.
[5]MARINI S,BUONANNO G,STABILE L,et al.Short term effects of electronic and tobacco cigarettes on exhaled nitric oxide[J].Toxicol Appl Pharmacol,2014,278(1):9-15.
[6]WESTERGAARD C G,PORSBJERG C,BACKER V.The effect of Varenicline on smoking cessation in a group of young asthma patients[J].Respir Med,2015,109(11):1416-1422.
[7]NEELAMEGAN R,SAKA V,TAMILARASU K,et al.Clinical utility of fractional exhaled nitric oxide(Fe NO)as a biomarker to predict severity of disease and response to inhaled corticosteroid(ICS)in asthma patients[J].J Clin Diagn Res,2016,10(12):1-6.
[8]ABDELBASSET W K,ALSUBAIE S F,TANTAWY S A,et al.E-valuating pulmonary function,aerobic capacity,and pediatric quality of life following a 10-week aerobic exercise training in schoolaged asthmatics:a randomized controlled trial[J].Patient Prefer Adherence,2018,12:1015-1023.
[9]ZHANG X,JOHNSON N,CARRILLO G,et al.Decreasing trend in passive tobacco smoke exposure and association with asthma in U.S.children[J].Environ Res,2018,166:35-41.
[10]CONTOLI M,KRAFT M,HAMID Q,et al.Do small airway abnormalities characterize asthma phenotypes In search of proof[J].Clin Exp Allergy,2012,42(8):1150-1160.
[11]杨琤瑜,杨冬,叶伶,等.吸烟对成人哮喘控制及气道炎性反应的影响[J].中国临床医学,2013,20(2):138-140.