|本期目录/Table of Contents|

[1]任成山,林 辉,杨仕明.循证医学应用中临床经验的重要性[J].中华肺部疾病杂志,2020,(03):293-296.[doi:10.3877/cma.j.issn.1674-6902.2020.03.001]
　Lou Yueyan,Zheng Yu,Zhang Liyan,et al.Clinical significance of fractional exhaled nitric oxide in asthma patients[J].,2020,(03):293-296.[doi:10.3877/cma.j.issn.1674-6902.2020.03.001]
点击复制

循证医学应用中临床经验的重要性(PDF)

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2020年03期
页码:
293-296
栏目:
循证医学与临床
出版日期:
2020-06-20

文章信息/Info

Title:
Clinical significance of fractional exhaled nitric oxide in asthma patients
作者:
任成山; 林 辉; 杨仕明
400037 重庆,陆军(第三)军医大学第二附属医院消化内科
Author(s):
Lou Yueyan;  Zheng Yu;  Zhang Liyan;  Zhu Feng;  Wu Xueling.
Department of Respiratory Medicine, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
关键词:
循证医学;  最佳证据;  临床实践;  临床经验;  临床证据;  医疗决策
Keywords:
Bronchial asthma;  Exhaled nitric oxide;  Lung functions;  Asthmatic control test scores;  Clinical significance
分类号:
R0
DOI:
10.3877/cma.j.issn.1674-6902.2020.03.001
摘要:
目的 哮喘以慢性气道炎性反应为特征,主要涉及嗜酸性粒细胞的募集和活化。呼出气一氧化氮(fractional exhaled nitric oxide, FeNO)是气道炎症的一个非侵入性标志物。本文探讨了FeNO在哮喘中的临床意义。方法 我们评估了94例哮喘患者治疗前后的FeNO和肺功能参数及哮喘控制检测(asthma control test, ACT)评分,其中完成1个月随访的有75例,完成3个月随访的有73例,分析了我院哮喘患者控制水平的一些相关因素。结果 发现诊断时的FEV1%在预测哮喘控制时最具优势,哮喘患者根据ACT评分划分的不同控制状态的FeNO和肺功能参数无明显差异。FeNO和肺功能参数,ACT评分及血IgE,血嗜酸性粒细胞计数之间无明显相关性。FEV1%与ACT评分之前存在正相关(r=0.04184,P=0.0492)。无过敏性鼻炎(allergic rhinitis, AR)组,FeNO和ACT评分之间存在负相关(r=0.2015,P=0.0128)。3个月治疗后FeNO和ACT评分之间仍无明显相关性。结论 哮喘患者治疗前后的FeNO可以评估患者的治疗效果,而FeNO并不能预测哮喘的控制状态及恶化风险,FEV1%在预测哮喘控制方面具有临床意义。
Abstract:
Objective Asthma is characterized by chronic airway inflammatory responses, mainly involving the recruitment and activation of eosinophils. Exhaled nitric oxide(FeNO)is a non-invasive marker of airway inflammation. The article aims to explore the clinical role of FeNO in asthma patients. Methods We evaluated the FeNO, the pulmonary function parameters and the asthmatic control test(ACT)scores of 94 asthma patients before and after treatment. Among them, 75 patients completed the follow-up visits for one month and 73 patients completed the follow-up visits for three months. We analyzed some related factors of the control level of asthma patients in our hospital. Results The percentage of forced expiratory volume in one second(FEV1%)at diagnosis had the most advantage in predicting asthma control, and there was no significant difference in FeNO and pulmonary function parameters of asthma patients according to the ACT scores. There was no significant correlation between FeNO and pulmonary function parameters, ACT scores, IgE and eosinophil count. There was a positive correlation between FEV1% and ACT scores(r=0.04184, P=0.0492). There was a negative correlation between FeNO and ACT scores in the allergic rhinitis(AR)group(r=0.2015, P=0.0128). There was no significant correlation between FeNO and ACT scores after 3 months of treatment. Conclusion FeNO before and after treatment can evaluate the therapeutic effect of the patients with asthma, but FeNO cannot predict the control status and the risk of asthma deterioration. FEV1% has more advantages in predicting asthma control.

参考文献/References:

1 许 锐, 陈前军. 人性化医疗与循证医学[J]. 医学与哲学, 2019, 40(23): 5-7, 10.
2 李幼平, 李 静, 孙 鑫, 等. 循证医学在中国的发展:回顾与展望[J]. 兰州大学学报:医学版, 2016, 42(1): 25-28.
3 Wang JY, Jin XJ. Evidence-based medicine in China[J]. Chronic Dis Transl Med, 2019, 5(1): 1-5.
4 Evidence-based medicine working group. Evidence-based medicine:A new approach to teaching the practice of medicine[J]. JAMA, 1992, 268(17): 2420-2425.
5 Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine:what it is and what it isn't[J]. BMJ, 1996, 312(7023): 70-72.
6 O'Sullivan JW, Albasri A, Koshiaris C, et al. Diagnostic test guidelines based on high-quality evidence had greater retes of adherence: a meta-epidemiological study[J]. J Clin Epidemiol, 2018, 103: 40-50.
7 Kelly MP. The need for a rationalist turn in evidence-based medicine[J]. J Eval Clin Pract, 2018, 24(5): 1158-1165.
8 Spence JD. The need for clinical judgement in the application of evidence-based medicine[J]. BMJ Evid Based Med, 2019: doi: 10.1136/bmjebm-2019-111300.
9 Jada G, Hamilton JG, Lillie SE, et al. What is a good medical decsion? A research agenda guided by perspectives from multiple stakeholders[J]. J Behav Med, 2017, 40(1): 52-68.
10 Dolan JG, Veazie PJ. Harnessing expert judgment to support clinical decisions when the evidence base is weak[J]. Med Decis Making, 2019, 39(1): 74-79.
11 刘哲然. 从经验医学、循证医学到精准医学的演变及评价[J]. 医学与哲学, 2017, 38(10B): 81-84.
12 Armitage J, Baigent C, Barnes E, et al. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials[J]. Lancet, 2019, 393(11): 407-415.
13 刘 俊. 正确运用循证医学证据指导临床实践[J]. 医学与哲学, 2019, 40(23): 15-18.
14 Fanaroff AC, Califf RM, Windecker S, et al. Levesls of evidence supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018[J]. JAMA, 2019, 321: 1069-1080.
15 Herrera-Perez D, Haslam A, Crain T, et al. A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals[J]. Elife, 2019, 8: e45183.
16 Huo Y, Li J, Qin X, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPTrandomized clinical trial[J]. JAMA, 2015, 313*(13): 1325-1335.
17 Emdn CA, Odutayo A, Hsiao AJ, et al. Association between randomised trial evidence and global burden of disease: cross sectional study(epidemiological study of randomized trials-ESORT)[J]. BMJ, 2015, 350: h117.
18 Rabinstein AA, Brinjikji W, Kallmes DF. Equipoise in clinical trials:angst and progress[J]. Circ Res, 2016, 119(7): 798-800.
19 Scott IA. Filling the Glass of Evidence-Based Medicine[J]. Intern Med J, 2020, 50(1): 15-16.
20 任成山, 林 辉, 杨仕明. 结核病的流行特征与耐多药的窘迫及其策略[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(3): 269-274.
21 任成山, 王关嵩, 钱桂生. 慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 127-141.
22 任成山, 林 辉, 杨仕明, 等. 冠状病毒及新型冠状病毒肺炎防控策略[J/CD]. 中华肺部疾病杂志(电子版), 2020, 13(1): 1-5.
23 关于印发新型冠状病毒肺炎诊疗方案(试行第七版)的通知. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml
24 Wan Y, Shang J, Graham R, et al. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus[J]. J Virol, 2020, 94(7): e00127-20.
25 20200608-COVIDv19-sitrep-140.pdf https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200608-COVID-19-sitrep-140.pdf?sfvrsn=2f310900_2
26 李少峰, 兰智慧, 张元兵, 等. 循证医学时代探讨名老中医经验传承模式的关键点[J]. 时珍国医国药, 2017, 28(4): 930-931.
27 Li L, Fu HQ. China's health care system reform: Progress and prospects[J]. Int J Health Plann Manage, 2017, 32(3): 240-253.
28 Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on[J]. Lancet, 2017, 390(10092): 415-423.
29 Kim K, Lee CJ, Shim CY, et al. Statin and clinical outcomes of primary prevention in individuals aged>75 years: The SCOPE-75 study[J]. Atherosclerosis, 2019, 284: 31-36.
30 Ouchi Y, Sasaki J, Arai H, et al. Ezetimibe lipid-lowering trial on prevention of atherosclerotic cardiovascular disease in 75 or older(EWTOPIA 75)[J]. Circulation, 2019, 140(12): 992-1003.

备注/Memo

备注/Memo:
基金项目: 国家自然科学基金资助项目(81773468)
更新日期/Last Update: 2020-06-20