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  • 王晓如,吴玲,张治,孔庆华,祁辉,雷撼.呼出气一氧化氮在指导支气管哮喘慢性持续期阶梯治疗中的应用[J].第二军医大学学报,2019,40(6):683-687    [点击复制]
  • WANG Xiao-ru,WU Ling,ZHANG Zhi,KONG Qing-hua,QI Hui,LEI Han.Application of fractional exhaled nitric oxide in stepped treatment of chronic persistent asthma[J].Acad J Sec Mil Med Univ,2019,40(6):683-687   [点击复制]
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呼出气一氧化氮在指导支气管哮喘慢性持续期阶梯治疗中的应用
王晓如1,吴玲1,张治1,孔庆华1,祁辉1,雷撼2*
0
(1. 上海市徐汇区大华医院呼吸内科, 上海 200237;
2. 同济大学附属东方医院呼吸内科, 上海 200120
*通信作者)
摘要:
目的 观察呼出气一氧化氮(FeNO)动态变化在指导支气管哮喘慢性持续期阶梯治疗中的应用效果。方法 以2016年1月至2017年12月在上海市徐汇区大华医院就诊的慢性持续性支气管哮喘患者为研究对象,随机分为研究组和对照组。两组患者均按2014年《全球哮喘防治创议》(GINA 2014)进行标准化治疗。所有患者每3个月进行病情评估,对照组按GINA 2014推荐的方案调整治疗,研究组患者在病情评估时检测FeNO并在GINA 2014推荐方案的基础上参考FeNO结果调整治疗。随访1年,比较两组患者的完全控制率、降阶梯治疗失败率、支气管哮喘控制问卷(ACQ)评分、肺功能。结果 共207例患者完成研究,对照组103例,研究组104例。研究组和对照组患者病情均得到有效控制,两组临床完全控制率、ACQ评分、肺功能差异均无统计学意义(P均>0.05),但研究组降阶梯治疗失败率低于对照组[7.28%(11/151)vs 13.66%(25/183),P<0.05],第4~6个月、第7~9个月、第10~12个月控制药物和短效按需缓解药物的使用剂量均少于对照组(P均<0.05)。结论 在病情评估的基础上通过动态监测FeNO可有效指导慢性持续性支气管哮喘的阶梯治疗,降低治疗失败率,减少控制药物和短效按需缓解药物的使用剂量。
关键词:  哮喘  呼出气一氧化氮  阶梯治疗  肺功能
DOI:10.16781/j.0258-879x.2019.06.0683
投稿时间:2018-10-23修订日期:2018-12-24
基金项目:
Application of fractional exhaled nitric oxide in stepped treatment of chronic persistent asthma
WANG Xiao-ru1,WU Ling1,ZHANG Zhi1,KONG Qing-hua1,QI Hui1,LEI Han2*
(1. Department of Respiratory Medicine, Shanghai Dahua Hospital of Xuhui District, Shanghai 200237, China;
2. Department of Respiratory Medicine, Eastern Hospital, Tongji University, Shanghai 200120, China
*Corresponding author)
Abstract:
Objective To explore the feasibility of fractional exhaled nitric oxide (FeNO) dynamic changes in guiding stepped treatment of patients with chronic persistent asthma. Methods From Jan. 2016 to Dec. 2017, chronic persistent asthma patients, who were admitted to Shanghai Dahua Hospital of Xuhui District, were enrolled and randomly divided into study and control groups. All patients were given standardized treatment according to Global Initiative for Asthma in 2014 (GINA 2014) and evaluated every 3 months to adjust their medications. The control group was adjusted according to the recommended protocol from GINA 2014, while the study group was adjusted according to the results of FeNO on the basis of the recommended protocol from GINA 2014. All patients were followed for 1 year. The complete control rate, failure rate of de-escalation treatment, Asthma Control Questionnaire (ACQ) score and lung function were compared between the two groups. Results Atotal of 207 patients were enrolled in this study, including 103 cases in the control group and 104 cases in the study group. The condition of the patients was effectively controlled in both study and control groups. There were no significant differences in total control rate, ACQ score or lung function between the two groups (all P>0.05), while the failure rate of de-escalation therapy was significantly lower in the study group than that in the control group (7.28%[11/151] vs 13.66%[25/183], P<0.05). In addition, the doses of controlled drugs and short-acting on-demand remission drugs in 4-6 months, 7-9 months and 10-12 months were significantly less in the study group than those in the control group (all P<0.05). Conclusion In the treatment of chronic persistent asthma, the dynamic monitoring of FeNO can effectively guide the medication, decrease the failure rate of treatment, and reduce the doses of controlled drugs and short-acting on-demand remission drugs.
Key words:  asthma  fractional exhaled nitric oxide  stepped treatment  lung function