摘要
目的:探讨呼出气一氧化氮(FeNO)与细胞因子检测在指导慢阻肺急性加重期(AECOPD)全身应用糖皮质激素治疗中的临床价值。方法:纳入2017年9月至2019年11月我院呼吸内科收治的100例AECOPD患者进行前瞻性随机对照研究。根据是否应用FeNO指导糖皮质激素治疗,随机分为FeNO指导组50例及对照组50例,以"27 ppb"为切点将实验组分为高、低FeNO组,其中高FeNO组22例(应用糖皮质激素治疗组),低FeNO组28例为未应用糖皮质激素治疗组。对照组50例(应用临床经验指导糖皮质激素治疗)分为应用糖皮质激治疗组(36例)和未应用糖皮质激素治疗组(14例)。分别测定各组研究对象IL-6、IL-8、TNF-α、嗜酸性粒细胞、肺功能、CAT评分、住院时间、激素不良反应等并进行比较。结果:治疗前,高FeNO组嗜酸性粒细胞直接计数、IL-6、IL-8、TNF-α水平显著高于其他组,与FeNO浓度呈正相关,以IL-6最为显著(P<0.05)。治疗后,观察组中IL-6、IL-8、TNF-α水平较对照组显著降低(P<0.05);FeNO指导组较对照组住院时间、住院费用、激素使用率、激素不良反应显著降低(P<0.05)。结论:FeNO水平和IL-6可有效评估AECOPD患者气道炎症水平,对指导AECOPD患者全身使用糖皮质激素具有良好的临床参考价值。
Objective:To investigate clinical value of exhaled nitric oxide(FeNO) in guiding systemic glucocorticoid therapy in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Enrolled 100 patients with AECOPD who admitted to our hospital from September 2017 to November 2019 for prospective randomized controlled study.Eligible patients were randomized into FeNO-guided group(n=50) and control group(n=50) according to whether employing glucocorticoid guidied by FeNO.Patients in FeNO-guided group was further divided into two subgroups using concentration of FeNO "27 ppb" at admission as cutoff.Patients in high-FeNO subgroup(n=22) received glucocorticoid treatment and those in low-FeNO subgroup(n=28) did not receive glucocorticoid treatment.Patients in control group were also divided into two subgroups according to clinical experience of doctors, with 36 patients received glucocorticoid treatment and 14 patients did not.Levels of IL-6,IL-8,TNF-α,eosinophils, lung function, CAT score, length of hospital stay, hormone adverse events of patients in each subgroup were measured and compared.Results:Before treatment, eosinophil count, IL-6,IL-8,and TNF-α in high-FeNO subgroup were significantly higher than those in other three subgroups, and was positively correlated with FeNO content, especially IL-6(P<0.05).After treatment, levels of IL-6,IL-8 and TNF-α in FeNO-guided group were significantly lower than those in control group(P<0.05).Compared with control group, hospitalization duration, hospitalization expenses, hormone utilization rate and hormone adverse reactions in FeNO guided group were significantly reduced(P<0.05).Conclusion:Level of FeNO and IL-6 can be used as indicators to effectively evaluate airway inflammatory status of patients with AECOPD,which has a good clinical reference value for guiding treatment of glucocorticoid in AECOPD.
作者
王晶
郭伟
侯丽萍
田迎
崔朝勃
王宁
宋竹翠
宋雅妹
WANG Jing;GUO Wei;HOU Li-Ping;TIAN Ying;CUI Chao-Bo;WANG Ning;SONG Zhu-Cui;SONG Ya-Mei(Respiratory and Critical Care Medicine,Hengshui People’s Hospital,Hengshui 053000,China)
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2021年第5期595-599,共5页
Chinese Journal of Immunology
基金
2018年河北省医学重点课题计划项目(20181572)。
