Clinical Application Of Alveolar Nitric Oxide In The Diagnosis And Treatment Of Chronic Obstructive Pulmonary Disease

Objective:(1)To analysis the relationship between alveolar nitric oxide(Ca NO)and leukocytes,eosinophils,C-reactive protein,procalcitonin,erythrocyte sedimentation,CAT(chronic obstructive pulmonary disease assessment test)scale and MMRC(Dyspnea Rating)scale scores in patients with acute exacerbation of chronic obstructive pulmonary disease and to investigate the relationship between Ca NO value and common inflammation markers and Clinical symptoms.(2)To compare the Ca NO value of patients with acute exacerbation of chronic obstructive pulmonary disease with healthy control group,and the changes of Ca NO value before and after treatment were discussed.So we can discusse the clinical significance of Ca NO value in the diagnosis and treatment of chronic obstructive pulmonary disease.Methods:Selected from September 1,2017 to March 1,2019 at the Department of Respiratory Clinic of the First Hospital of Ji Lin University and diagnosed as acute exacerbation of chronic obstructive pulmonary disease according to GOLD,There were 197 hospitalized patients,including 116 males and 81 females,aged 54.45 ±5.78 years.41 healthy persons were selected,23 males and 18 females,aged 46.73 ±6.27 years.The first stage: The patients enrolled on the day of admission who were admitted to the hospital immediately improved their blood routine,C-reactive protein,procalcitonin,and erythrocyte sedimentation rate and other routine inflammation indicators.At the same time,they performed exhaled nitric oxide detection to obtain Fe NO and Ca NO values,and recorded their CAT scores and MMRC score.According to the GOLD classification standard,all patients were divided into mild to moderate COPD and severe extremely severe COPD.The clinical characteristics and Ca NO value of all patients were analyzed,and the Ca NO value was compared with clinical characteristics and conventional inflammation indicators to explore the correlation between them.Fe NO and Ca NO were also detected in healthy subjects in the control group.The second stage: Admitted patients were given inhaled glucocorticoids and bronchodilators(?-receptor agonist combined with cholinergic blockers)for aerosolized inhalation treatment,while antibiotics were given for anti-infection,doxofylline and bromhexine etc to expectorant.Fe NO and Ca NO values were rechecked in 79 patients.Compare the differences between Ca NO and Fe NO values before and after treatment in patients with COPD,healthy people and COPD patients,and analyze the possible reasons for this difference.Result:(1)The Ca NO value of COPD patients was positively correlated with the absolute value of blood eosinophils and Fe NO value(r = 0.23,r = 0.383,p value<0.01).Ca NO value was not related to the percentage of neutrophils,C-reactive protein,procalcitonin,and erythrocyte sedimentation rate.(2)Ca NO value has no correlation with CAT score and m MRC score,and this value has no correlation with GOLD classification.(3)Compared with the healthy control group,the Ca NO value of COPD patients was 12.5(8.35-19.00)ppb,which was significantly higher than the control group 5.50(2.25-7.90)ppb,the difference was statistically significant(p <0.01).(4)The median Ca NO value(interquartile range)of COPD Smoking patients was11.65(8.28-20.45)ppb,the median Ca NO of COPD but not smoking or quitting for more than 1 year was 13.8(8.25-18.7)ppb.The difference was not statistically significant(Z =-0.502,p = 0.616).(5)The Ca NO value of COPD patients before treatment was compared with that after treatment.The value was 12.4(7.60-17.00)ppb after treatment,which was a decrease compared with 17.6(10.70-24.10)ppb before treatment,and the difference was statistically significant(p <0.05).Compared with the change of Fe NO value before and after treatment,the change of Ca NO value is relatively small,and the difference between the two changes is also statistically significant(p <0.01).Conclution:(1)The Ca NO value of patients with COPD in acute exacerbation is positively correlated with the absolute value of peripheral blood eosinophils and Fe NO value,which can be combined with Fe NO value to reflect the eosinophilic inflammation of small airway and airway,respectively.Ca NO level cannot reflect the severity of COPD.(2)The Ca NO value of AECOPD patients is higher than that of healthy people,and smoking has no effect on Ca NO value.The Ca NO value of AECOPD patients decreased after treatment,which can more accurately reflect the presence of small airway inflammation in patients with COPD.After treatment,the decrease of Ca NO value is lower than that of Fe NO value,It is suggested that compared with airway inflammation,small airway inflammation is not sensitive to conventional ICS.