连续测定工作及休息期间呼出气一氧化氮在职业性哮喘方面的诊断
2019/08/28
摘要
背景：吸入特定物质前后的呼出气一氧化氮（FeNO）测定已被假定为职业性哮喘（OA）诊断的辅助检查，但关于在家庭及工作中FeNO的测量知之甚少。本研究的目的是评估在家庭及工作期间连续测量FeNO对OA诊断的影响。
方法：拟诊（n = 35）或确诊（n = 6）OA的41名受试者在为期2周的假期及随后2周的工作期间每天进行一次FeNO测量。认为工作期间测量的FeNO值增加大于等于20 ppb（十亿分之一）为阳性结果。对于阴性结果或吸入特定物质引起FeNO增加大于等于20ppb存有疑虑的受试者通过根据所有可能信息单独进行全体专家评审。
结果：疑似35名受试者中的7名（20％）疑诊OA，6名受试者中的3名（50％）确诊OA显示与工作相关的FeNO增加值大于等于20ppb。7名疑诊OA的中有6个患者根据FeNO的变化程度通过全体专家评审后确诊为OA。
结论：在工作前后连续FeNO测定为大约五分之一疑诊OA的病人中提供诊断性辅助信息，尤其是当特定吸入物质结果阴性或不能进行时。
Serial fractional exhaled nitric oxide measurements off and at work in the diagnosis of occupational asthma.
van Kampen V, Brüning T, Merget R
Abstract
BACKGROUND: Fractional exhaled nitric oxide (FeNO) before and after specific inhalation challenge has been postulated as an additional tool in the diagnosis of occupational asthma (OA), but little is known about serial FeNO measurements at home and at work. The aim of the present study was to assess the contribution of serial measurements of FeNO off and at work toward the diagnosis of OA.
METHODS: Forty-one subjects with suspected (n = 35) or diagnosed (n = 6) OA performed FeNO measurements once daily during a 2-week holiday and a subsequent 2-week work period. A work-related increase in FeNO by 20 ppb (parts per billion) or more was considered positive. Subjects with negative or doubtful specific inhalation challenge but a FeNO increase of 20 ppb or more were evaluated individually by an overall expert rating taking into account all available information.
RESULTS: Seven of 35 subjects (20%) with suspected and three of six subjects (50%) with diagnosed OA showed a work-related FeNO increase of 20 ppb or more. Six of the seven with suspected OA were reclassified as having an OA diagnosis by the overall expert rating which also considered these FeNO changes.
CONCLUSIONS: Serial FeNO measurements off and at work provide complementary information in the diagnosis in about one-fifth of cases with suspected OA, especially if specific inhalation challenges are negative or cannot be performed.
背景：吸入特定物质前后的呼出气一氧化氮（FeNO）测定已被假定为职业性哮喘（OA）诊断的辅助检查，但关于在家庭及工作中FeNO的测量知之甚少。本研究的目的是评估在家庭及工作期间连续测量FeNO对OA诊断的影响。
方法：拟诊（n = 35）或确诊（n = 6）OA的41名受试者在为期2周的假期及随后2周的工作期间每天进行一次FeNO测量。认为工作期间测量的FeNO值增加大于等于20 ppb（十亿分之一）为阳性结果。对于阴性结果或吸入特定物质引起FeNO增加大于等于20ppb存有疑虑的受试者通过根据所有可能信息单独进行全体专家评审。
结果：疑似35名受试者中的7名（20％）疑诊OA，6名受试者中的3名（50％）确诊OA显示与工作相关的FeNO增加值大于等于20ppb。7名疑诊OA的中有6个患者根据FeNO的变化程度通过全体专家评审后确诊为OA。
结论：在工作前后连续FeNO测定为大约五分之一疑诊OA的病人中提供诊断性辅助信息，尤其是当特定吸入物质结果阴性或不能进行时。
（中日友好医院呼吸与危重症医学科 张 鑫 摘译 林江涛 审校）
（Am J Ind Med. 2019 Aug;62(8):663-671. doi: 10.1002/ajim.22996.）
（Am J Ind Med. 2019 Aug;62(8):663-671. doi: 10.1002/ajim.22996.）
Serial fractional exhaled nitric oxide measurements off and at work in the diagnosis of occupational asthma.
van Kampen V, Brüning T, Merget R
Abstract
BACKGROUND: Fractional exhaled nitric oxide (FeNO) before and after specific inhalation challenge has been postulated as an additional tool in the diagnosis of occupational asthma (OA), but little is known about serial FeNO measurements at home and at work. The aim of the present study was to assess the contribution of serial measurements of FeNO off and at work toward the diagnosis of OA.
METHODS: Forty-one subjects with suspected (n = 35) or diagnosed (n = 6) OA performed FeNO measurements once daily during a 2-week holiday and a subsequent 2-week work period. A work-related increase in FeNO by 20 ppb (parts per billion) or more was considered positive. Subjects with negative or doubtful specific inhalation challenge but a FeNO increase of 20 ppb or more were evaluated individually by an overall expert rating taking into account all available information.
RESULTS: Seven of 35 subjects (20%) with suspected and three of six subjects (50%) with diagnosed OA showed a work-related FeNO increase of 20 ppb or more. Six of the seven with suspected OA were reclassified as having an OA diagnosis by the overall expert rating which also considered these FeNO changes.
CONCLUSIONS: Serial FeNO measurements off and at work provide complementary information in the diagnosis in about one-fifth of cases with suspected OA, especially if specific inhalation challenges are negative or cannot be performed.
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哮喘与非哮喘患者咳嗽频率模式的临床特点
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健康和哮喘患者呼出生物标志物的昼夜节律
