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Lancet Respir Med:通过呼出的一氧化氮就能测定患者吸入糖皮质激素后的疗效

2017-12-26 吴星 环球医学

2017年11月,发表于《Lancet Respir Med》上的一项随机对照试验,考察了呼出气一氧化氮(FeNO)作为非特异性呼吸症状和非显著性支气管扩张剂可逆性的患者在吸入糖皮质激素后的反应的预测因子的效果。

2017年11月,发表于《Lancet Respir Med》上的一项随机对照试验,考察了呼出气一氧化氮(FeNO)作为非特异性呼吸症状和非显着性支气管扩张剂可逆性的患者在吸入糖皮质激素后的反应的预测因子的效果。

背景:慢性非特异性呼吸症状难以管理。本试验旨在评估基线FeNO与非特异性呼吸症状患者对吸入性糖皮质激素的应答之间的相关性。

方法:在这项双盲、随机、安慰剂对照试验中,研究者纳入了未诊断的18~80岁具有咳嗽、喘息或呼吸困难且使用支气管扩张剂可逆性仍低于20%的患者。患者来自于英国和新加坡26家初级医疗中心和医院。患者在随机分组前评估了2周,之后按照1:1的比例随机分配至4周的超细吸入性糖皮质激素(QVAR 80μg,每天两次,每次两喷,等效于每天800μg倍氯米松二丙酸酯)或安慰剂的组中。根据基线FeNO测量对随机分组进行分层:正常(≤25十亿分率(ppb))、中等(>25~<40ppb)、高(≥40ppb)。首要终点为哮喘控制调查问卷(ACQ7)平均分数的改变。使用广义线性模型评估FeNO作为应答的预测因素,评估FeNO和治疗对ACQ7改变的相互作用。研究人员按方案集中进行了首要和次要分析,并排除了未完成首要终点的患者、对治疗不依从的患者(通过患者报告确认)以及在预先定义的就诊窗外进行访问的患者。

结果:在2015年2月4日~2016年7月12日,研究者将294例患者随机分配至超细吸入性糖皮质激素治疗组(148例)和安慰剂组(146例)。排除了违反协议的患者后,研究者共分析了214例患者(114例超细吸入性糖皮质激素和100例安慰剂)。研究者注意到,基线FeNO和治疗组之间的显着相互作用在基线FeNO每增加10个ppb时,超细吸入性糖皮质激素组比安慰剂组ACQ7的改变更高(组间差异,0.071;95% CI,0.002~0.139;P=0.044)。最常见的不良反应为鼻咽炎[治疗组18例(12%)安慰剂组13例(9%)]、感染和寄生虫感染[25(17%)vs 21(14%)]、呼吸、胸、纵隔疾病[13(9%)vs 17(12%)]。

结论:在非特异性呼吸症状患者的临床实践中,FeNO测量是一种简便而非侵袭性的工具,可以用来预测吸入糖皮质激素的反应。需要进一步研究来检测其在治疗其他气道疾病证据中的作用,如慢性阻塞性肺疾病。

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