論文No1755
Combined value of exhaled nitric oxide and blood eosinophils in chronic airway disease: the Copenhagen General Population Study
Yunus Çolak, Shoaib Afzal, Børge G. Nordestgaard, Jacob L. Marott, Peter Lange
European Respiratory Journal 52 (2) 1800616; DOI: 10.1183/13993003.00616-2018 Published 2 August 2018
＜目的＞
我々は一般人口の慢性気道疾患において呼気一酸化窒素(FeNO)と好酸球の増加の組み合わせに追加的価値があるかを検討した。
＜方法＞
コペンハーゲン総合人口研究から20-100歳の467名を解析した。
気管支拡張剤前後の肺機能、自己申告の喘息、喫煙歴にもとづき、
参加者は健康非喫煙者(1649名)、健康既喫煙者(1581名)、喘息(449名)、COPD(404名)、
喘息COPD overlap(ACO)(138名)、非特異的気流閉塞(456名)に分類された。
＜結果＞
FeNO <25ppbかつ血中好酸球300未満と比較して、
喘鳴に対する年齢性別補正のオッズ比(95% CI)は
FeNO 25ppb以上あるいは血中好酸球300以上の群で1.54 (1.29–1.84)、
FeNO 25ppb以上かつ血中好酸球 300以上の群で2.14 (1.47–3.10)であった。
喀痰ありに対するオッズ比は同様に1.13 (0.91–1.41) and 1.83 (1.20–2.79)であり、
喘息に対するオッズ比は1.54 (1.22–1.94) and 3.26 (2.16–4.94)であり、
COPDに対するオッズ比は1.03 (0.80–1.32) and 0.67 (0.36–1.27)であり、
ACOに対するオッズ比は1.32 (0.88–1.96) and 2.14 (1.05–4.36)であった。
呼吸症状のある患者では慢性気道疾患のタイプを予測するのは
２つのバイオマーカーで差がなく、組み合わせても変わらなかった。
＜感想＞
FeNOと血中好酸球を組み合わせることで、喘鳴、喀痰、喘息、COPD、ACOのリスクが効率よく予測できたようです。
We investigated whether the combination of increased exhaled nitric oxide fraction (FeNO) level and blood eosinophil count had an additive value in chronic airway disease in the general population.
We included 4677 individuals aged 20–100 years from the Copenhagen General Population Study. Based on pre- and post-bronchodilator spirometry, self-reported asthma and smoking history, participants were subdivided into healthy never-smokers (n=1649), healthy ever-smokers (n=1581), asthma (n=449), chronic obstructive pulmonary disease (COPD) (n=404), asthma–COPD overlap (ACO) (n=138) and nonspecific airflow limitation (n=456).
Compared to individuals with FeNO <25 ppb and blood eosinophils <0.3×109 cells·L−1, age- and sex-adjusted odds ratios (95% CI) for wheezing were 1.54 (1.29–1.84) for individuals with FeNO ≥25 ppb or blood eosinophils ≥0.3×109 cells·L−1 and 2.14 (1.47–3.10) for individuals with FeNO ≥25 ppb and blood eosinophils ≥0.3×109 cells·L−1. Corresponding odds ratios were 1.13 (0.91–1.41) and 1.83 (1.20–2.79) for sputum production, 1.54 (1.22–1.94) and 3.26 (2.16–4.94) for asthma, 1.03 (0.80–1.32) and 0.67 (0.36–1.27) for COPD and 1.32 (0.88–1.96) and 2.14 (1.05–4.36) for ACO. Among individuals reporting respiratory symptoms, predicting the type of chronic airway disease did not differ between the two biomarkers and did not improve by combining them.
Combination of FeNO and blood eosinophils may have an additive value in characterising chronic airway disease in the general population but still needs to be investigated further with regard to clinical application.