痰嗜酸粒细胞、25(OH)D_3、FeNO检测在ACOS疾病诊断中的应用价值
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摘要
目的分析诱导痰嗜酸粒细胞、25-羟基维生素D_3[25(OH)D_3]、呼出气一氧化氮(FeNO)在哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)疾病诊断中的意义。方法选取陕西省榆林市第一医院2016年1月～2018年5月50例确诊为ACOS患者作为观察组,50例慢性阻塞性肺疾病患者作为对照组。分析各组痰嗜酸粒细胞、25(OH)D_3、FeNO水平,并绘制ROC曲线分析各指标诊断价值。结果观察组患者嗜酸粒细胞及25(OH)D_3水平均低于对照组(P <0.05),且观察组患者FeNO水平高于对照组,差异有统计学意义(P <0.05);观察组患者嗜酸粒细胞、25(OH)D_3及FeNO阳性率均高于对照组,差异有统计学意义(P <0.05);且FeNO诊断的灵敏度高于25(OH)D_3(P <0.05),且其特异度高于嗜酸粒细胞(P <0.05),ROC曲线下面积高于25(OH)D_3(P <0.05)。结论采用痰嗜酸粒细胞、25(OH)D_3、FeNO对ACOS疾病进行诊断时具有较高的应用价值,但FeNO诊断价值明显高于痰嗜酸粒细胞和25(OH)D_3。
Objective To analyze the significance of induced sputum eosinophils, 25-hydroxyvitamin D [25(OH) D_3] and exhaled nitric oxide(FeNO) in the diagnosis of asthma-copd overlap syndrome(ACOS). Methods From January 2016 to May 2018, 50 patients diagnosed with ACOS in the First Hospital of Yulin City, Shaanxi Province were selected as the observation group and 50 patients with chronic obstructive pulmonary disease as the control group, the levels of phlegm eosinophils, 25(OH) D_3 and FeNO in each group were analyzed, and ROC curves were drawn to analyze the diagnostic value of each index. Results The levels of eosinophil and 25(OH) D_3 in the observation group were lower than those in the control group(P < 0.05), and FeNO level in the observation group was higher than that in the control group(P <0.05). The positive rates of eosinophil, 25(OH) D_3 and FeNO in the observation group were all higher than those in the control group, with statistically significant differences(P < 0.05). In addition, the sensitivity of FeNO diagnosis was higher than 25(OH) D_3(P < 0.05), the specificity was higher than that of eosinophil(P < 0.05), and the area under the ROC curve was higher than 25(OH) D_3(P < 0.05). Conclusion The use of phlegm eosinophils, 25(OH) D_3 and FeNO in the diagnosis of ACOS disease has a high application value, but the diagnostic value of FeNO is significantly higher than that of phlegm eosinophils and 25(OH) D_3.
Objective To analyze the significance of induced sputum eosinophils, 25-hydroxyvitamin D [25(OH) D_3] and exhaled nitric oxide(FeNO) in the diagnosis of asthma-copd overlap syndrome(ACOS). Methods From January 2016 to May 2018, 50 patients diagnosed with ACOS in the First Hospital of Yulin City, Shaanxi Province were selected as the observation group and 50 patients with chronic obstructive pulmonary disease as the control group, the levels of phlegm eosinophils, 25(OH) D_3 and FeNO in each group were analyzed, and ROC curves were drawn to analyze the diagnostic value of each index. Results The levels of eosinophil and 25(OH) D_3 in the observation group were lower than those in the control group(P < 0.05), and FeNO level in the observation group was higher than that in the control group(P <0.05). The positive rates of eosinophil, 25(OH) D_3 and FeNO in the observation group were all higher than those in the control group, with statistically significant differences(P < 0.05). In addition, the sensitivity of FeNO diagnosis was higher than 25(OH) D_3(P < 0.05), the specificity was higher than that of eosinophil(P < 0.05), and the area under the ROC curve was higher than 25(OH) D_3(P < 0.05). Conclusion The use of phlegm eosinophils, 25(OH) D_3 and FeNO in the diagnosis of ACOS disease has a high application value, but the diagnostic value of FeNO is significantly higher than that of phlegm eosinophils and 25(OH) D_3.
引文
[1]Kolsum U,Donaldson GC,Singh R,et al.Blood and sputum eosinophils in COPD;relationship with bacterial load[J].Respir Res,2017,18(1):88.
[2]张瓒,黄天霞,于虹,等.支气管哮喘、慢性阻塞性肺疾病和支气管哮喘-慢性阻塞性肺疾病重叠综合征的临床和肺功能特点对比[J].广西医学,2017,39(8):1262-1264.
[3]Demarche SF,Schleich FN,Paulus VA,et al.Is it possible to claim or refute sputum eosinophils≥3%in asthmatics with sufficient accuracy using biomarkers?[J].Respir Res,2017,18(1):133.
[4]何忠,郑锐,谭明旗.哮喘-COPD重叠综合征的临床特征[J].国际呼吸杂志,2017,37(16):1207-1210.
[5]Casado B,Iadarola P,Pannell LK,et al.Protein expression in sputum of smokers and chronic obstructive pulmonary disease patients:a pilot study by CapLC-ESI-Q-TOF[J].J Proteome Res,2016,6(12):4615-4623.
[6]孙永昌.哮喘-慢阻肺重叠综合征指南解读[J].中国呼吸与危重监护杂志,2014(4):325-329.
[7]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志:电子版,2013,36(4):255-264.
[8]杨海,杨小兰,陈远东,等.检测诱导痰嗜酸性粒细胞在哮喘病情评估中的应用[J].实用医学杂志,2012,28(6):993-994.
[9]Kim HB,Eckel SP,Kim JH,et al.Exhaled NO:Determinants and Clinical Application in Children With Allergic Airway Disease[J].Allergy Asthma Immunol Res,2016,8(1):12-21.
[10]张瓒,黄天霞,于虹,等.支气管哮喘、慢性阻塞性肺疾病和支气管哮喘-慢性阻塞性肺疾病重叠综合征的临床和肺功能特点对比[J].广西医学,2017,39(8):1262-1264.
[11]Meng Y,Lou H,Wang C,et al.Predictive significance of computed tomography in eosinophilic chronic rhinosinusitis with nasal polyps[J].Int Forum Allergy Rhinol,2016,6(8):812-819.
[12]Zhang R,Luo W,Liang Z,et al.Eotaxin and IL-4 levels are increased in induced sputum and correlate with sputum eosinophils in patients with nonasthmatic eosinophilic bronchitis[J].Medicine,2017,96(13):e6492.
[13]Amin K,Janson C,Bystrom J.Role of Eosinophil Granulocytes in Allergic Airway Inflammation endotypes[J].Scand J Immunol,2016,84(2):75-85.
[14]程小秋,邓笑伟.体检人群25羟基-维生素D与肺功能相关的研究[J].临床肺科杂志,2017,22(10):1854-1858.
[15]Byeon JH,Ri S,Amarsaikhan O,et al.Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma[J].Allergy Asthma Immunol Res,2017,9(6):509-516.
[16]Greulich T,Hohlfeld JM,Neuser P,et al.A GATA3-specific DNAzyme attenuates sputum eosinophilia in eosinophilic COPD patients:a feasibility randomized clinical trial[J].Respir Res,2018,19(1):55.
[17]Tiscoski NR,Valente BM,De SMV,et al.Pharmacological modulation of reactive oxygen species(ROS)improves the airway hyperresponsiveness by shifting the Th1 response in allergic inflammation induced by ovalbumin[J].Free Radic Res,2017,51(7):1.
[18]Wang W,Xian M,Xie Y,et al.Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma[J].Allergy,2016,71(3):378-386.
[19]Jacinto T,Malinovschi A,Janson C,et al.Differential effect of cigarette smoke exposure on exhaled nitric oxide and blood eosinophils in healthy and asthmatic individuals[J].J Breath Res,2017,11(3):036006.
[20]王志华.维生素D辅助治疗在儿童不同严重程度支气管哮喘患儿中的应用效果[J].中国医药导报,2018,15(3):85-88.
[21]宋颖芳,赖国祥,柳德灵,等.1,25-二羟维生素D3负性调控被动致敏人气道平滑肌细胞中的NF-κB信号通路[J].中国病理生理杂志,2013,29(11):2044-2048.
[22]孙妍,王英,陈晓晶,等.血清25-羟维生素D3水平与婴儿喘息的相关分析[J].中国现代医生,2017,55(14):25-27.
[23]Byeon JH,Ri S,Amarsaikhan O,et al.Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma[J].Allergy Asthma Immunol Res,2017,9(6):509-516.
[24]Kumar RM,Pajanivel R,Koteeswaran G,et al.Correlation of total serum immunoglobulin E level,sputum,and peripheral eosinophil count in assessing the clinical severity in bronchial asthma[J].Lung India,2017,34(3):256-261.
[2]张瓒,黄天霞,于虹,等.支气管哮喘、慢性阻塞性肺疾病和支气管哮喘-慢性阻塞性肺疾病重叠综合征的临床和肺功能特点对比[J].广西医学,2017,39(8):1262-1264.
[3]Demarche SF,Schleich FN,Paulus VA,et al.Is it possible to claim or refute sputum eosinophils≥3%in asthmatics with sufficient accuracy using biomarkers?[J].Respir Res,2017,18(1):133.
[4]何忠,郑锐,谭明旗.哮喘-COPD重叠综合征的临床特征[J].国际呼吸杂志,2017,37(16):1207-1210.
[5]Casado B,Iadarola P,Pannell LK,et al.Protein expression in sputum of smokers and chronic obstructive pulmonary disease patients:a pilot study by CapLC-ESI-Q-TOF[J].J Proteome Res,2016,6(12):4615-4623.
[6]孙永昌.哮喘-慢阻肺重叠综合征指南解读[J].中国呼吸与危重监护杂志,2014(4):325-329.
[7]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中国医学前沿杂志:电子版,2013,36(4):255-264.
[8]杨海,杨小兰,陈远东,等.检测诱导痰嗜酸性粒细胞在哮喘病情评估中的应用[J].实用医学杂志,2012,28(6):993-994.
[9]Kim HB,Eckel SP,Kim JH,et al.Exhaled NO:Determinants and Clinical Application in Children With Allergic Airway Disease[J].Allergy Asthma Immunol Res,2016,8(1):12-21.
[10]张瓒,黄天霞,于虹,等.支气管哮喘、慢性阻塞性肺疾病和支气管哮喘-慢性阻塞性肺疾病重叠综合征的临床和肺功能特点对比[J].广西医学,2017,39(8):1262-1264.
[11]Meng Y,Lou H,Wang C,et al.Predictive significance of computed tomography in eosinophilic chronic rhinosinusitis with nasal polyps[J].Int Forum Allergy Rhinol,2016,6(8):812-819.
[12]Zhang R,Luo W,Liang Z,et al.Eotaxin and IL-4 levels are increased in induced sputum and correlate with sputum eosinophils in patients with nonasthmatic eosinophilic bronchitis[J].Medicine,2017,96(13):e6492.
[13]Amin K,Janson C,Bystrom J.Role of Eosinophil Granulocytes in Allergic Airway Inflammation endotypes[J].Scand J Immunol,2016,84(2):75-85.
[14]程小秋,邓笑伟.体检人群25羟基-维生素D与肺功能相关的研究[J].临床肺科杂志,2017,22(10):1854-1858.
[15]Byeon JH,Ri S,Amarsaikhan O,et al.Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma[J].Allergy Asthma Immunol Res,2017,9(6):509-516.
[16]Greulich T,Hohlfeld JM,Neuser P,et al.A GATA3-specific DNAzyme attenuates sputum eosinophilia in eosinophilic COPD patients:a feasibility randomized clinical trial[J].Respir Res,2018,19(1):55.
[17]Tiscoski NR,Valente BM,De SMV,et al.Pharmacological modulation of reactive oxygen species(ROS)improves the airway hyperresponsiveness by shifting the Th1 response in allergic inflammation induced by ovalbumin[J].Free Radic Res,2017,51(7):1.
[18]Wang W,Xian M,Xie Y,et al.Aggravation of airway inflammation and hyperresponsiveness following nasal challenge with Dermatophagoides pteronyssinus in perennial allergic rhinitis without symptoms of asthma[J].Allergy,2016,71(3):378-386.
[19]Jacinto T,Malinovschi A,Janson C,et al.Differential effect of cigarette smoke exposure on exhaled nitric oxide and blood eosinophils in healthy and asthmatic individuals[J].J Breath Res,2017,11(3):036006.
[20]王志华.维生素D辅助治疗在儿童不同严重程度支气管哮喘患儿中的应用效果[J].中国医药导报,2018,15(3):85-88.
[21]宋颖芳,赖国祥,柳德灵,等.1,25-二羟维生素D3负性调控被动致敏人气道平滑肌细胞中的NF-κB信号通路[J].中国病理生理杂志,2013,29(11):2044-2048.
[22]孙妍,王英,陈晓晶,等.血清25-羟维生素D3水平与婴儿喘息的相关分析[J].中国现代医生,2017,55(14):25-27.
[23]Byeon JH,Ri S,Amarsaikhan O,et al.Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma[J].Allergy Asthma Immunol Res,2017,9(6):509-516.
[24]Kumar RM,Pajanivel R,Koteeswaran G,et al.Correlation of total serum immunoglobulin E level,sputum,and peripheral eosinophil count in assessing the clinical severity in bronchial asthma[J].Lung India,2017,34(3):256-261.