南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (8): 1410-1416.doi: 10.12122/j.issn.1673-4254.2023.08.19

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肺泡一氧化氮在间质性肺疾病诊断及鉴别中的应用价值

常潇丹，陈美佳，廖 画，董航明，蔡绍曦   

  1. 南方医科大学南方医院呼吸与危重症医学科，护理学院，广东 广州 510515
  • 出版日期:2023-08-20 发布日期:2023-09-11

Alveolar nitric oxide concentration has a potential value in the diagnosis and differential diagnosis of interstitial lung diseases

CHANG Xiaodan, CHEN Meijia, LIAO Hua, DONG Hanming, CAI Shaoxi   

  1. Department of Respiratory and Critical Care Medicine, Nanfang Hospital, School of Nursing, Southern Medical University, Guangzhou 510515, China
  • Online:2023-08-20 Published:2023-09-11

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摘要： 目的 探讨呼出气一氧化氮（eNO）在间质肺疾病诊断及鉴别诊断中的应用价值。方法 根据欧洲呼吸学会关于eNO的指南，收集68例健康者和45例间质性肺疾病（ILD）患者，其中包括18例结缔组织相关间质性肺疾病（CTD-ILD），27例非结缔组织相关间质性肺疾病（non CTD-ILD），在流速50 mL/s和200 mL/s时检测呼出气一氧化氮（FeNO）值和肺泡一氧化氮（CaNO）值，比较组间及亚组间eNO差异，应用受试者工作特征曲线（ROC）分析eNO的预测价值。并在ILD组探索CaNO与肺功能指标的相关性。结果 ILD组CaNO、FeNO50、FeNO200水平高于健康对照组（P<0.05）；Logistic回归分析显示CaNO和FeNO200是发生ILD的危险因素；ROC曲线分析显示CaNO和FeNO200联合诊断ILD的曲线下面积为0.829（95% CI：0.752~0.906）。在ILD组中，CaNO水平与肺一氧化碳弥散量占预计值的百分比呈负相关（r=-0.471，P<0.05）。ILD组中分组比较显示CTD-ILD组CaNO值明显高于非CTD-ILD组（P<0.05）。ROC曲线分析显示CaNO鉴别CTD-ILD和非CTD-ILD曲线下面积为0.725（95%CI：0.576~0.875）。结论 CaNO在诊断ILD和鉴别CTD-ILD方面具有一定的价值。

关键词: 间质性肺疾病；结缔组织相关间质性肺病；呼出气一氧化氮；肺泡一氧化氮

Abstract: Objective To investigate the value of exhaled nitric oxide (eNO) in the diagnosis and differential diagnosis of interstitial lung disease (ILD). Methods This study was conducted among 45 patients with interstitial lung disease, including 18 with connective tissue disease- related ILD (CTD- ILD) and 27 with non-CTD-ILD, with 68 healthy subjects as the control group. According to European Respiratory Association Guidelines, alveolar nitric oxide (CaNO) concentration and fractional exhaled nitric oxide (FeNO) level were measured at the flow rates of 50 and 200 mL/s. The predictive level of CaNO was analyzed using receiver-operating characteristic curve (ROC), and the correlations between CaNO and pulmonary function indicators were examined in the patients with ILD. Results CaNO, FeNO50, and FeNO200 levels were significantly higher in patients with ILD than in the healthy controls. Logistic regression analysis showed that lowered levels of CaNO and FeNO200 were risk factors for ILD. ROC curve analysis showed that the area under the curve (AUC) of CaNO combined with FeNO200 was 0.829 (95% CI: 0.752-0.906) for the diagnosis of ILD. In patients with ILD, CaNO levels were negatively correlated with DLCO%pred (r=-0.471, P<0.05). Subgroup comparison showed a significantly higher CaNO level in CTD- ILD group than in non-CTD- ILD group. The AUC for CaNO to discriminate CTD- ILD from non-CTD-ILD was 0.725 (95% CI: 0.576 to 0.875). Conclusion CaNO has a potential value in the diagnosis of ILD and differential diagnosis of CTD-ILD.

Key words: interstitial lung disease; connective tissue disease related interstitial lung disease; fraction of exhaled nitric oxide; concentration of alveolar nitric oxide