| Objective: To discuss the influence of smoking on Fe NO expression in patients with chronic airway inflammation.Methods: 1. The clinical medical records of 206 cases of patients were collected who see a doctor in pneumology department of Tianjin Medical University General Hospital from January 2015 to October 2015, and all the patients were both in a chronic airway inflammation stable period. According to patients with long-term chronic cough, coughing phlegm up, breathing, atopic medical history and lung function characteristics, dividing the 206 patients into COPD(chronic obstructive pulmonary disease) group(124 cases), ACOS(asthma and chronic obstructive pulmonary disease overlap syndrome) group(37 cases), and asthma group(45 cases). Meanwhile, the people accepted healthy physical examination(40 cases) as the healthy control group. Then dividing the people of the four groups into smokers or nonsmokers according to the situation of smoking.Comparing the Fe NO value and pulmonary function index between the four groups, and the Fe NO value of smokers and nonsmokers in the four groups were respectively compared at the same time.At last, respectively making correlation analysis on smoking index and Fe NO value, FEV1% and Fe NO value of smokers in each group. 2. Making a receiver operator characteristic curve of asthma group and ACOS group with Fe NO values, and calculating the Fe NO threshold that can diagnose asthma and asthma and chronic obstructive pulmonary disease overlap syndrome, finally obtain the relevant sensitivity, specific degree, positive predictive value and negative predictive value. 3. The 51 cases of smoking patients in a chronic obstructive pulmonary disease stable period were selected as the research object and accepted the education about quitting smoking, and then these patients were followed-up for up to half a year. To record and collate the quit smoking situation and whether have had acute aggravating circumstances of patients during the follow-up period in detail, and regularly review Fe NO, FEV1% and FEV1/FVC, as well as COPD Assessment Test of patients. According to the concrete quit smoking condition of all patients during the follow-up period, it can be divided into quit smoking group(has quit smoking during the follow-up period) and smoking group(has not quit smoking during the follow-up period). Then make statistical analysis on the change of Fe NO, related lung function index(FEV1%, FEV1/FVC) as well as the CAT score before and after the follow-up in each group.Results: 1. The Fe NO value of ACOS group and asthma group were significantly higher than that of COPD group and the control group(32.6±9.9、37.6±10.9 vs 18.7±9.8、14.4±4.3, F=68.082, P<0.05). However, when comparing ACOS group and asthma group, and meanwhile comparing COPD group and the control group, the Fe NO value were no significant difference(2.6±9.9 vs 37.6±10.9, P>0.05);(18.7±9.8 vs 14.4±4.3, P>0.05). 2. The FEV1% and FEV1/FVC of ACOS group、COPD group and asthma group were significantly lower than control group. The FEV1/FVC of ACOS group and COPD group were significantly lower than asthma group(P<0.05), however, there is no difference about FEV1% between ACOS group, COPD group and asthma group(P>0.05). 3. The Fe NO and FEV1% of patients in each group have no obvious correlation. 4. The Fe NO value of smokers in COPD group and ACOS group were significantly lower than non-smokers(P<0.05). However, the Fe NO value of smokers and nonsmokers in asthma group and the control group have no significant difference(P>0.05). 5. The smoking index and Fe NO value were significantly negative correlation in COPD group. However, there was no obvious correlation between smoking index and Fe NO values in other group. 6. When taking 23.5ppb as Fe NO cut points in the diagnosis of asthma, the sensitivity was 92%, the specificity was 97.5%, and the corresponding positive predictive value and negative predictive value were 97.6% and 90.7%, respectively. When taking 25.5ppb as Fe NO cut points in the diagnosis of ACOS, the sensitivitywas 94.1%, the specificity was 40.0%, and the corresponding positive predictive value and negative predictive value were 100% and 81.63%, respectively. 7. Making quit smoking education on 51 cases of patients in the chronic obstructive pulmonary disease stable period, then these patients were followed-up for half a year.We found that the Fe NO value after quitting smoking is higher than that before quitting smoking(19.5±5.3 VS 15.2±4.5, P<0.05), the CAT score after quitting smoking is lower than that before quitting smoking(13.2±2.4 vs 18.6±3.5, P<0.05) of the 20 cases patients in quit smoking group.However, when comparing the FEV1 % and EFV1/FVC, we found that they have no significant difference before and after quitting smoking(P>0.05). The Fe NO value and FEV1/FVC of the 25 patients in smoking group had no significant difference when compared with that before follow-up(P>0.05).However, the FEV1% was lower than before(50.1±7.1 vs 55.2±6.2, P<0.05), and the CAT score was higher than before(22.3±2.5 vs 18.2±2.8, P<0.05).Conclusions: 1. On account of smoking could reduce the Fe NO value of patients with chronic obstructive pulmonary disease and ACOS, therefore, the Fe NO basic value(cut point 25 ppb) which evaluating the smoking patients with chronic obstructive pulmonary disease should take into consideration to reduce in this circumstances. 2. The results showed that quitting smoking could increase the Fe NO value of patients with chronic obstructive pulmonary disease to a certain extent and could also effectively improve CAT score. 3. When the Fe NO was applied to the diagnosis of asthma, it had high sensitivity and specificity.However, when the Fe NO was applied to the diagnosis of ACOS, although had high sensitivity, the specificity was worse. 4. It was obvious that the role of Fe NO detection on the diagnosis of asthma superior to the diagnosis of chronic obstructive pulmonary disease, and the Fe NO detection could help to identify the chronic obstructive pulmonary disease combined with asthma. |
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