鄭雅文周明智許正園Jeng-Yuan Hsu醫學研究所2026-10-292021-03-112013https://handle.ncl.edu.tw/11296/vf5666https://scholars.csmu.edu.tw/handle/123456789/35946研究目的：本研究目的在探討呼氣一氣氧化氮測定(FeNO)在慢性呼吸道疾病，如氣喘及慢性咳嗽病人之鑑別診斷及治療效果評估之使用價值。研究方法及資料：本論文使用NOA 280i NO分析儀作FeNO測定，共進行五個研究，探討台灣正常健康人之參考值，比較離線測試與線上測試之差異，並應用於慢性呼吸道疾病，如氣喘急慢性咳嗽之鑑別診斷及治療效果評估。研究結果：本論文第一個研究訂出249位健康成年人的FeNO平均值為27.9 ppb；第二個研究中發現線上及離線FeNO值有很好的相關性(r = 0.908, p < 0.001)，可由回歸公式預估線上FeNO值(ppb)為2.233 × 離線FeNO值(ppb) - 6.236。第三個研究中22位病人之FeNO值與痰液中major basic protein (MBP)染色陽性細胞(即嗜酸性球)之比率無相關(r=0.158, N.S)，但是MBP染色陽性細胞比率超過3%與5%者各為19位(90.5%)及16位(76.2%)。第四個研究的結果顯示氣喘良好控制組(ACT評分≧20)之FeNO顯著低於控制不良組，且ACT評分與FeNO數值呈負相關(r = -0.596)。第五個研究發現，38位經吸入型類固醇治療而咳嗽完改善者(A組)與32位未使用吸入型類固醇但咳嗽改善者(C組)之FeNO數值有顯著差異(57.1 ppb vs. 22.4 ppb，p < 0.005)。若以FeNO 33.9 ppb作為使用吸入型類固醇治療慢性咳嗽的界線值，敏感性及特異性各為94.7%及76.3%。結論與建議：經由以上五個研究，研究者可做出以下結論：FeNO在嗜酸性球發炎引起的呼吸道發炎疾病，尤其是氣喘與慢性不明原因咳嗽，有很高的診斷價值，並可作為氣喘控制狀況的輔助指標。未來的臨床應用上，可使用研究者訂出之健康人參考值判斷病人是否有嗜酸性球發炎引起的呼吸道發炎疾病；對於年紀較大、或因吹氣技巧無法完成線上FeNO測定的病人，可使用研究者訂出的公式，由離線FeNO值推估病人的線上FeNO值。Objective: To evaluation the usefulness of FeNO measurement in patients with eosinophilic inflammatory airway disease, such as bronchial asthma and chronic cough.Material and Method: A nitric oxide analyzer (NOA 280i) was used to conduct five experiments. In the first experiment, 249 Taiwanese non-smoking healthy adults were enrolled to determine the reference values of FeNO in Taiwan. In the second experiment, the correlations between offline and online FeNO data of 56 patients were evaluated. In the third experiment, the correlations between FeNO level and % of major basic protein (MBP) positive sputum cells (eosinophils) were compared. In the fourth experiment, we investigated possible correlations between ACT scores and FeNO values in 73 outpatient visits made by 60 asthmatic patients. In the fifth experiment we reviewed the medical records of 81 patients with chronic cough, to compare the FeNO level and the response to inhaled corticosteroid treatment in these patients.Results: The result of the first experiment showed that the mean FeNO in 249 Taiwanese non-smoking healthy adults was 27.9ppb. In multivariate regression analyses, age and lung function (FVC or FEV1) were positively associated with the FeNO values. In the second experiment, a high correlation between online and offline FeNO levels (r = 0.908, p < 0.001) were observed. The predicted online FeNO level (ppb) = 2.233 × offline FeNO level (ppb) - 6.236. In the third experiment, no correlation between FeNO level and percentage of major basic protein (MBP) positive sputum cells (eosinophils) were seen, but in 19 and 16 patients, the % of MBP positive cells was higher than 3% and 5% respectively. The result of the fourth experiment showed the mean FeNO value was higher in patients reported their ACT scores were≧20 than those who reported the ACT scores were＜20. There was a negative correlation between ACT scores and FeNO values (r = -0.596). In the fifth experiment, significant difference in FeNO value was seen in patients whose cough responded good to ICS treatment.ROC analysis showed that a FeNO of 33.9 ppb was the best cut-off value for using ICS (sensitivity 94.7%, specificity 76.3%).Conclusions: After conducting these five experiments, we found that FeNO measurement is a versatile, easy-to-use, non-invasive diagnostic tool for assessing inflammatory airway diseases. By using the reference FeNO value and the formula for predicting online data that we have devised, FeNO measurement can be applied to patients for evaluating eosinophilic inflammation of the airways.thesis