FeNO、CaNO及EOS联合诊断哮喘-COPD重叠的效能及其与患者病情严重程度的相关性分析

Efficacy of FeNO, CaNO and EOS in the Combined Diagnosis of Asthma-COPD Overlap and Its Correlation Analysis with the Severity of Patients’ Disease

摘要: 目的：探究FeNO、CaNO及EOS联合诊断哮喘-COPD重叠的效能，并分析FeNO、CaNO及EOS与患者病情严重程度的相关性。方法：设计回顾性病例对照研究，选取2018年1月1日~2021年1月1日于上海交通大学医学院附属苏州九龙医院诊治的哮喘-COPD重叠患者80例作为观察组，并选取同期入我院检查的非哮喘非COPD健康志愿者80例作为对照组。回顾两组患者的性别、年龄、BMI、过敏史、吸烟史等基线资料，以及FeNO、CaNO、外周血EOS、CRP、PCT、总IgE等检查结果，比较两组患者临床资料及检查结果的组间差异。采用受试者工作曲线分析FeNO、CaNO及EOS的效能，并计算各指标的最优临界值。以各指标的最优临界值为基础分析FeNO、CaNO及EOS三个指标二联、三联诊断ACO的临床效能。另外将观察组患者分为稳定期和急性加重期两个亚组，比较不同病情严重程度患者FeNO、CaNO及EOS的差异。结果：1) 两组患者性别、年龄、BMI指数等基线资料比较差异无统计学意义(P > 0.05)，观察组患者过敏史、吸烟指数≥400的比例均显著高于对照组(P < 0.05)。2) 观察组患者FeNO、CaNO水平及外周血EOS、CRP、PCT、总IgE水平均显著高于对照组(P < 0.05)。3) 采用ROC曲线分析将FeNO、CaNO及EOS采取两两串联的方式进行ACO诊断价值评价，结果显示“FeNO + CaNO”、“FeNO + EOS”以及“CaNO + EOS”的曲线下面积均显著高于单一指标诊断。“FeNO + CaNO + EOS”表示为满足FeNO、CaNO及EOS其中任意2项为诊断依据，“FeNO + CaNO + EOS”诊断ACO的敏感度为98.75%、特异度为97.50%、PPV为97.53%、NPV为98.73%、准确度为98.13%、AUC为0.958 (0.715, 0.989)。“FeNO + CaNO + EOS”诊断ACO的价值显著优于FeNO、CaNO及EOS#单一指标以及“FeNO + CaNO”、“FeNO + EOS”以及“CaNO + EOS”，诊断价值最高。4) 亚组间比较，急性加重组的FeNO、CaNO及EOS水平显著高于稳定期组(P < 0.05)。结论：FeNO + CaNO + EOS的诊断模型是ACO患者临床诊断的有效方式，能够有效提高ACO的诊断准确率；FeNO、CaNO及EOS在ACO患者中具有较高的检测价值，其水平与患者的病情严重程度具有相关性，值得在临床参考使用。

Abstract: Objective: To explore the efficacy of FeNO, CaNO and EOS in the combined diagnosis of asthma-COPD overlap, and to analyze the correlation between FeNO, CaNO, EOS and the severity of patients’ disease. Methods: A retrospective case-control study was designed, and 80 asthma-COPD overlap patients treated in Suzhou Kowloon Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2018 to January 1, 2021 were selected as the observation group, and 80 non-asthmatic and non-COPD healthy volunteers enrolled in our hospital during the same period were selected as the control group. Baseline data, such as gender, age, BMI, history of allergy and smoking, as well as FeNO, CaNO, peripheral blood EOS, CRP, PCT and total IgE, were reviewed between the two groups, and the differences in clinical data and examination results were compared between the two groups. The effectiveness of FeNO, CaNO and EOS was analyzed by using the subject operating curve, and the optimal critical values of each index were calculated. Based on the optimal critical values of each index, the clinical efficacy of FeNO, CaNO and EOS for dual and triple ACO diagnosis was analyzed. In addition, the observation group was divided into two subgroups: stable stage and acute exacerbation stage, and the differences of FeNO, CaNO and EOS in patients with different severity of disease were compared. Results: 1) There was no statistical significance in gender, age, BMI and other baseline data between the two groups (P > 0.05), and the proportion of allergy history and smoking index ≥400 in observation group was significantly higher than that in control group (P < 0.05). 2) The levels of FeNO and CaNO and the levels of EOS, CRP, PCT and total IgE in peripheral blood in observation group were significantly higher than those in control group (P < 0.05). 3) ROC curve analysis was used to evaluate the ACO diagnostic value of FeNO, CaNO and EOS in tandem. The results showed that the area under the curve of “FeNO + CaNO”, “FeNO + EOS” and “CaNO + EOS” were significantly higher than that of single indicator diagnosis. “FeNO + CaNO + EOS” means that any two of FeNO, CaNO and EOS are the diagnostic basis. The sensitivity, specificity, PPV, NPV, accuracy and AUC of “FeNO + CaNO + EOS” for ACO diagnosis were 98.75%, 97.50%, 97.53%, 98.73%, 98.13% and 0.958 (0.715, 0.989). The diagnostic ACO value of “FeNO + CaNO + EOS” was significantly superior to FeNO, CaNO and EOS# single index as well as “FeNO + CaNO”, “FeNO + EOS” and “CaNO + EOS”, showing the highest diagnostic value. 4) The levels of FeNO, CaNO and EOS in acute plus recombination group were significantly higher than those in stable group (P < 0.05). Conclusion: FeNO + CaNO + EOS diagnostic model is an effective way to diagnose ACO patients, and can effectively improve the accuracy of ACO diagnosis. FeNO, CaNO and EOS have high detection value in ACO patients, and their levels are correlated with the severity of patients’ conditions, which are worthy of clinical reference.