化學發光法之臨床應用－氣喘病人與吐氣一氧化氮濃度之相關探討

吳蕙真 ； 朱家成 ； 劉清揚 ； 王家弘

《呼吸治療》 2卷1期 (2003/01) Pp. 27-43

https://doi.org/10.6269/JRT.2003.2.1.05

摘要

氣喘病患因呼吸道發炎而使呼吸道上皮細胞分泌一氧化氮，因此利用化學發光法來測量吐氣中所含的一氧化氮濃度可作為呼吸道發炎的指標。
本研究的吐氣一氧化氮濃度測量方法有兩種，一是以吐氣受限之線上（on-line restricted exhaled breath）測量，另一種則是將受測者所吐出的氣體收集在Mylar Bag後，再分析Mylar Bag中氣體的一氧化氮濃度。我們測量45位健康個體（對照組），on-line ENO平均值為12.562 ±1.032 ppb，BAG NO平均值為5.973 ±0.411 ppb，及59位接受類固醇治療的氣喘病人（病例組），共測量8週的吐氣一氧化氮濃度和肺功能，第一週（基準值）的on-line ENO平均值為
30.844 ±3.855 ppb，BAG NO平均值為18.103 ±2.352 ppb；結果顯示，病例組無論是on-line ENO或BAG NO值皆顯著比對照組來的高，且有統計顯著差異（p＜0.05）。而對照組和病例組on-line ENO及BAG NO兩種測量方法之相關分析，則顯示on-line ENO比BAG NO值高，兩者有統計顯著差異（p＜0.05），且兩者成正相關（r＞0.5）。
本研究的病例組皆接受類固醇治療，而類固醇之使用劑量、方法、途徑是醫師根據病人病情來調整。在類固醇治療之後，臨床上發現其on-line ENO及BAG NO在第2、3、4週兩者平均值皆是下降的，第5、6週呈上升趨勢，第7、8兩週濃度則又下降。但是類固醇和各週的on-line ENO及BAG NO之間在統計上並無明顯差異（p＞0.05）。而肺功能之第一秒最大吐氣量（FEV1）和吐氣一氧化氮濃度兩者之間，在統計上也無明顯差異（p＞0.05）。
我們的結論是，吐氣一氧化氮濃度在氣喘病人較健康個體為高，線上（on-line ENO）測量方法比儲氣袋收集（BAG NO）測量方法的值來的高並且兩者為正相關。每個病人在類固醇治療劑量、方法、途徑不一樣的狀況下，較難看出類固醇和吐氣一氧化氮濃度兩者之間的相關。而吐氣一氧化氮濃度和肺功能之第一秒最大吐氣量（FEV1）之間並無顯著相關。（呼吸治療2003;1(1):27～43）

關鍵字

化學發光法 ； 氣喘 ； 吐氣一氧化氮濃度 ； 儲氣帶收集

並列摘要

Asthmatic patients’ respiratory epithelium excrete nitric oxide (NO) due to airway inflammation. Thus, we use chemiluminesce method to measure the concentratron of exhaled nitric oxide(ENO) that is a maker of airway inflammation.
In this thesis, were two methods were performed for measurement of ENO. 1. ENO was performed via a on-line restricted exhaled breath. 2. Subjects exhaled air was collected into a Mylar bag, and then analyzed the ENO of the Mylar bag. We measured 45 normal subjects whose on-line ENO meam level was 12.562± 1.032ppb and BAG NO mean level was 5.973 ±0.411ppb. We also measured 59 asthmatic patients who treated with steroids. ENO and pulmonary function test (FFV1) were measured for 8 weeks. Their baseline mean level of on-line ENO was 30.844±3.855 and BAG NO were 18.103±2.352ppb. Results show the asthmatic patoents on-line ENO and BAG NO were higher healthy controls and there was statistically sihaificant change (p＜0.05). On-line ENO level was higher than BAG NO level There was Statistically significant change (p＜0.05) and a correlation between them (r＞0.5).
After steroids treated, asthmatic subiects the level of on-line ENO and BAG NO fell at wk2、wk3、wk4, increased at wk5、wk6 and fell at wk7、wk8 again. But there was no significant correlate between steroids and ENO and BAG NO of every week (p＞0.05). There was no statistically change between FEV1 and ENO, too (P.0.05).
Our conclusion is that asthmatic subiects ENO was higher than normal subjects. The level of on-line ENO was higher BAG NO and there was a correlation between them. Aftre steroids treated, the level of ENO was unstable. There was no significant correlated between ENO and FEV1.