张琳　王临英　陈卫松　　朱丹　　俞龙

[摘要] 目的 分析支氣管哮喘患者小气道与上气道炎症相关性的临床研究。 方法 选取浙江大学医学院附属金华医院2018年9月至2019年9月收治的60例初诊支气管哮喘患者，按照其上气道炎症指标鼻呼出一氧化氮（nNO）水平，将患者分别纳入低水平组（nNO<500 ppb）、高水平组（nNO≥500 ppb），根据哮喘病情控制分级开展对应治疗，对比两组患者治疗前后哮喘控制测试（ACT）评分、肺功能、总免疫球蛋白E（IgE）以及呼出气一氧化氮（FeNO）、肺泡一氧化氮（CaNO）浓度变化，分析小气道炎症指标（CaNO）与上气道炎症（nNO）的相关性，及其与患者预后的关联。 结果 60例患者中，39例nNO≥500 ppb，纳入高水平组，其余21例纳入低水平组。两组治疗1年后ACT评分均较治疗前升高，低水平组治疗前、治疗1年后ACT评分均高于高水平组，差异有统计学意义（P<0.05）。两组治疗1年后FVC、FEV1/FVC、FEV1%pred、PEF均较治疗前升高，低水平组治疗前、治疗1年后上述指标均高于高水平组，差异有统计学意义（P<0.05）。两组治疗1年后IgE、FeNO、CaNO、nNO均较治疗前下降，低水平组治疗前、治疗1年后上述指标均低于高水平组，差异有统计学意义（P<0.05）。Pearson相关性分析示，nNO与CaNO呈正相关（r=0.688，P<0.05）。完全控制+部分控制组治疗前IgE、FeNO、CaNO、nNO均低未控制组，差异有统计学意义（P<0.05）。 结论 支气管哮喘患者小气道与上气道炎症状态密切相关，且小气道、上气道炎症反应越明显，其病情控制难度更高。

[关键词] 支气管哮喘;小气道;上气道炎症;相关性

[中图分类号] R562.25          [文献标识码] B          [文章编号] 1673-9701（2021）12-0103-05

Clinical study of the correlation between small airway and upper airway inflammation in patients with bronchial asthma

ZHANG Lin1   WANG Linying2   CHEN Weisong2   ZHU Dan2   YU Long2

1.Department of Otorhinolaryngology， Head and Neck Surgery， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China; 2.Department of Respiratory Medicine， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China

[Abstract] Objective To analyze the clinical study of the correlation between small airway and upper airway inflammation in patients with bronchial asthma. Methods Sixty patients with newly diagnosed bronchial asthma who were admitted to the Affiliated Jinhua Hospital of Zhejiang University School of Medicine from September 2018 to September 2019 were selected. According to their upper airway inflammation index， nasal exhaled nitric oxide （nNO） levels， the patients were divided into the low-level group （nNO<500 ppb）， high-level group （nNO≥500 ppb）. The corresponding treatment was carried out according to the asthma control grading. The asthma control test（ACT） scores， lung function， total immunoglobulin E（IgE） as well as changes in the concentration of exhaled nitric oxide（FeNO） and alveolar nitric oxide （CaNO） between the two groups before and after treatment were compared. The correlation between small airway inflammation indicators（CaNO） and upper airway inflammation（nNO）， and its association with patient prognosis was analyzed. Results Among the 60 patients， 39 patients with nNO≥500 ppb were included in the high-level group， and the remaining 21 patients were included in the low-level group. The ACT scores of the two groups were higher after one year of treatment than before treatment. The ACT scores of the low-level group were higher than those of the high-level group before and after one year of treatment. The difference was statistically significant （P<0.05）. The FVC， FEV1/FVC， FEV1%pred， and PEF of the two groups after one year of treatment were all higher than those before treatment. The above indicators of the low-level group were higher than those of the high-level group before treatment and one year after treatment. The difference was statistically significant（P<0.05）. The IgE， FeNO， CaNO， and nNO of the two groups decreased after one year of treatment. The above indicators of the low-level group before treatment and after one year of treatment were lower than those of the high-level group， and the difference was statistically significant（P<0.05）. Pearson correlation analysis showed that nNO and CaNO were positively correlated， r=0.688（P<0.05）. IgE， FeNO， CaNO， and nNO in the complete control+partial control group were lower before treatment in the uncontrolled group， and the difference was statistically significant（P<0.05）. Conclusion In patients with bronchial asthma， the small airway and upper airway inflammation are closely related， and the more obvious the inflammation of the small airway and upper airway， the more difficult it is to control the disease.

[Key words] Bronchial asthma; Small airway; Upper airway inflammation; Correlation

支气管哮喘是一种慢性炎症性呼吸系统疾病，与气道高反应性、气道炎症密切相关，其病理生理改变包括平滑肌痉挛、上皮破损、细胞脱落、炎性细胞浸润、气道水肿所致气道阻塞等[1]。数据表明，我国目前支气管哮喘患者超过3000万，且发病率、住院率呈上升趋势，据估计，到2025年，全球新发哮喘患者将达到1亿[2]。既往研究显示，哮喘患者呼出气一氧化氮（FeNO）显著高于非哮喘人群，故FeNO已成为气道炎症的主要监测指标[3]，近年来，也有研究发现，鼻呼出一氧化氮（nNO）可反映上呼吸道炎症、肺泡一氧化氮（CaNO）浓度则与小气道炎症密切相关[4]。因此，在支气管哮喘的治疗与管理中，同时监测FeNO、nNO和CaNO，有望为病情控制、预后评估提供一定参考。然而，目前临床尚无关于支气管哮喘患者小气道与上气道炎症相关性及其对患者预后影响的报道，为弥补这一空白，此次研究选取60例患者开展对照分析，现报道如下。

1 对象与方法

1.1 研究对象

将我院2018年9月至2019年9月收治的60例支气管哮喘患者纳入此次病例对照研究。患者纳入标准：（1）参照2017年版全球……