The Values Of Fractional Exhaled Nitric Oxide In Acute Exacrbations Of Chronic Obstructive Pulmonary Diseases

Objective(1) Analyze fractional exhaled nitrie oxide (FENO) value of hospitalized acute exacrbations of chronic obstructive pulmonary diseases (AECOPD) patients, asthmatic patients and healthy contrasts; compare FENO value of hospitalized AECOPD patients and the content of interleukin-6(IL-6) and interleukin-5(IL-5) in their exhaled breath condensate (EBC) before and after treatment; explore the function of FENO in assessing airway inflammation of hospitalized AECOPD patients.(2) Analyze the relationship between FENO value and curative effect of hospitalized AECOPD patients before treatment; explore the assessment significance of FENO value assay to therapeutic effect of hospitalized AECOPD patients.Method(1) Regard80cases of hospitalized AECOPD patients,40cases of hospitalized asthmatic patients and40healthy contrasts as the research object and use exhaled nitric oxide measurement instrument NIOXMINO determine FENO value; determine forced expiratory volume in one second(FEV1) and forced expiratory volume in one second/predicated value (FEV1%) at the same time.(2) After hospitalized AECOPD patients having comprehensive treatment including systemic hormones, to determine their FENO value, FEV1and FEV1%, and to record the hospitalized days of the patients at the same time.(3) Select14cases of hospitalized AECOPD patients randomly and11healthy contrasts, using exhaled condensate collection apparatus EcoScreen to collect EBC of hospitalized AECOPD patients before and after treatment and the healthy contrasts separately. Apply enzyme-linked immunosorbent assay (ELISA) to examine the content of IL-5and IL-6in EBC.(4) Regard the FEV1increasing in absolute value greater than or equal to200ml and the increased percentage are greater than or equal to12%after treatment as index having treatment response. Different FENO cut-off points correspond to effective treatment sensitivity and specificity of hospitalized AECOPD patients, and according which to portray ROC curve and obtain the optimal cut-off point of FENO value. To group the hospitalized AECOPD patients on the basis of the optimal cut-off point, and to analyze separately the FEV1%, FEV1and treatment days of the two groups of patients before and after treatment.Result(1) The FENO values of AECOPD patients and patients with asthma are higher than healthy contrasts; the FENO value of patients with asthma is higher than AECOPD patients; the FENO value of AECOPD patients decreases after the treatment;(2) The content of IL-6and IL-5in EBC of AECOPD patients is higher than healthy contrasts, and the content of both decrease after the treatment;(3) Compare hospitalized AECOPD patients before and after the treatment, FENO value decreases, FEV1and FEV1%increase; there is no correlation between FENO values and FEV1, FEV1%before the treatment; the FENO value and drop-out value before treatment are positively correlated with the improvements of FEV1%and FEV1after the treatment; the FENO value before the treatment is negatively correlated with the hospitalized days.(4) The underneath area of receiver operator characteristic (ROC) curve is0.80and the optimum cut-off value of FENO is25.5part per billion (ppb). Regard FENO>25.5ppb as standard to calculate, with the result of that the effective treatment sensitivity degree is81.8%, and specificity degree is80.9%.(5) There is no statistically significance of the difference of FEV1and FEV1%before and after treatment of the group of hospitalized patients with AECOPD<25.5ppb; there is statistically significance of the difference of FEV1and FEV1%before and after treatment of the group with FENO>25.5ppb; and the hospitalized day of the latter is lower than the former.Conclusion(1) The method of exhaled nitric oxide assay is simple and convenient, with advantages of noninvasive, repeatable and strict quality control. The FENO values of AECOPD patients are higher than the healthy group and lower than the asthmatic patients. FENO values of AECOPD patients decrease after the treatment; suggesting that FENO can reflect airway inflammation of AECOPD patients and also the difference of airway inflammation between the AECOPD patients and the asthmatic patients.(2) Both the IL-6and IL-5of AECOPD patients are higher than healthy contrasts before treatment, and the index decreases distinctively after treatment, which illustrate that both IL-6and IL-5can reflect airway inflammation of AECOPD patients.(3) There exists correlation between FENO value and its decrease degree and the improvement of pulmonary function after treatment, which illustrate that determine the FENO may be can predict the treatment response of the hospitalized AECOPD patients.