本文選題：呼出氣一氧化氮　切入點：儀器比較　出處：《復旦大學》2013年博士論文　論文類型：學位論文

【摘要】：第一部分兩種呼出氣一氧化氮測定儀器的應用比較 目的：比較兩種呼出氣一氧化氮儀器,分析他們測定結果的關聯與一致性。 方法：本研究共納入45例受試者,包括：(1)健康志愿者；(2)支氣管哮喘患者；(3)慢性阻塞性肺疾病患者；(4)診斷未明確但有呼吸系統癥狀者。受試者以隨機順序進行同時段兩種呼出氣一氧化氮分析儀器(Sunvou納庫倫一氧化氮分析儀和Niox Mino)的檢測,測定呼吸流速為50m1/s下的呼出氣一氧化氮濃度。統計學分析采用SPSS19.0。 結果：兩種儀器的測定結果對比未見顯著性差異(P=0.1047),且具有良好的相關性(r=0.8647,P0.0001),并擬合出轉換方程：FeNONiox Mino=0.6233(SE=0.0552)×FeNOSunvou+10.38(SE=2.78)。將健康志愿者與哮喘患者分組分析,亦未發(fā)現測定結果之間存在顯著差異。Bland-Atman分析發(fā)現雖然兩種儀器總體測定結果的一致性較差,但多集中于測試高值。 結論：Sunvou納庫倫一氧化分析儀與Niox Mino測定結果之間具有良好的相關性。這一結果為臨床兩種儀器測定結果的比較與解讀提供了參考,同時也為后續(xù)利用納庫倫一氧化氮分析儀進行多呼氣流速下呼出氣一氧化氮測定的可靠性與準確性提供了依據。 第二部分阻塞性睡眠呼吸暫停低通氣綜合征患者分段呼出氣一氧化氮的測定與意義 目的：利用二室模型對呼出氣一氧化氮進行分段測定,探索阻塞性睡眠呼吸暫停低通氣綜合征(OSAHS)患者中呼出氣一氧化氮的變化與意義。 方法：根據入組、排除標準,本研究共納入非OSAHS對照組(Non-OS AHS)受試者27例,OSAHS患者32例。所有受試者記錄基本信息、Epworth嗜睡量表(ESS)評分,并進行常規(guī)肺功能測定和同時段(20：00-21：00)的分段呼出氣一氧化氮測定。其中所有OSAHS者均記錄多導睡眠監(jiān)測相關指標。統計學分析采用SPSS19.0. 結果：通過對比Non-OSAHS組,我們發(fā)現在OSAHS患者中：(1) FeNO (50ml/s)和J'awNO測定結果顯著升高,FeNO (50ml/s)與呼吸暫停低通氣指數(AHI)、夜間平均氧飽和度(Sa02)、夜間SaO290%占總睡眠時間的百分比以及夜間SaO290%的總睡眠時間等顯著相關；J'awNO亦與AHI、夜間Sa0290%睡眠時間、以及夜間Sa0290%睡眠時間占總睡眠時間的百分比具有顯著相關性；(2)CANO略有降低,與多導睡眠監(jiān)測相關指標無相關性；(3)FeNO(50ml/s)、 J'awNO和CANO均未顯示與ESS評分具有關聯。 結論：OSAHS存在大氣道(呼吸道導氣部)的炎癥、氧化應激水平增高,且與疾病的嚴重程度相關。CANO的降低可能與缺氧、炎癥所致的內皮功能障礙有關,其潛在機制還有賴于進一步研究。對OSAHS患者進行分段呼出氣一氧化氮的測定,可為深入認識發(fā)病機制與疾病監(jiān)測提供幫助。 第三部分經鼻持續(xù)氣道內正壓通氣對重度OSAHS患者分段呼出氣一氧化氮的影響與意義 目的：探索經鼻持續(xù)氣道正壓通氣(nCPAP)治療對重度OSAHS患者分段呼出氣一氧化氮水平的影響及其潛在臨床意義。 方法：根據入組、排除標準,本部分研究共納入接受連續(xù)3晚CPAP治療的重度OSAHS患者30例。記錄受試者基本信息,且在每次nCPAP治療前(晚睡前)、后(晨起后)均進行分段呼出氣一氧化氮的測定；采集治療前后靜脈血測定血漿內皮素-1(ET-1)濃度；并在治療前后行超聲心動圖檢查評價右室功能。統計學分析采用SPSS19.0。 結果：所有受試者均接受了nCPAP治療前后的分段呼出氣一氧化氮測定；20例受試者同意進行治療前后靜脈血采集,測定血漿ET-1濃度；22例受試者同意進行超聲心動圖檢查評價右室功能；13例受試者完整地接受了治療前后的心超檢查。結果發(fā)現：(1) FeNO (50ml/s)、J'awNO經nCPAP治療后均顯著降低；CANO則顯著上升；(2)對比治療前后同時段血漿ET-1濃度變化發(fā)現連續(xù)3晚nCPAP治療可顯著降低其濃度,且OSAHS患者CANO的變化與血漿ET-1濃度的變化趨勢之間具有一致性,但變化程度上并不具相關性；(3) nCPAP治療可改善右室功能,使做功減少,表現為Tei指數降低,而Tei指數與患者血漿ET-1濃度之間存在顯著正相關。 結論：對重度OSAHS患者進行分段呼出氣一氧化氮檢測具有反映肺部炎癥、氧化應激水平、內皮損傷與功能障礙、血管活性物質、肺循環(huán)阻力及右心功能變化等作用,對改善因OSAHS可能導致的遠期心血管事件或許有重要參考價值,有助于疾病的臨床治療、監(jiān)測與隨訪。
[Abstract]:The first part of the application of two kinds of exhaled nitric oxide measuring instruments
Objective: To compare two kinds of exhaled nitric oxide instruments and analyze the correlation and consistency of their results.
Methods: 45 patients were enrolled in the study subjects: (1) healthy volunteers; (2) patients with bronchial asthma; (3) in patients with chronic obstructive pulmonary disease; (4) the diagnosis is not clear but the symptoms of respiratory system. At the same time the subjects were two kinds of exhaled nitric oxide in analytical instruments random order (Sunvou Na Kulun nitric oxide analyzer and Niox Mino) detection, determination of respiratory flow rate of exhaled nitric oxide concentration of 50m1/s. Statistical analysis by SPSS19.0.
Results: the results of two kinds of instruments compared with no significant difference (P=0.1047), and has a good correlation (r=0.8647, P0.0001), and fit the conversion equation: FeNONiox Mino=0.6233 (SE=0.0552) * FeNOSunvou+10.38 (SE=2.78). The group of healthy volunteers and patients with asthma, also found no significant difference between the determination results of.Bland-Atman the analysis found that although the two instruments overall results consistency is poor, but more concentrated in the test of high value.
Conclusion: there is a good correlation between Sunvou nano Kulun oxide analyzer and Niox Mino results. Provide a reference comparison and interpretation of the results for the clinical determination results of two kinds of instruments, but also the accuracy and reliability of exhaled nitric oxide measurement provides the basis for the subsequent use of nano Kulun nitric oxide analyzer multi expiratory flow.
Determination and significance of sectional exhaled nitric oxide (NOS) in second parts of obstructive sleep apnea hypopnea syndrome
Objective: To explore the change and significance of exhaled nitric oxide in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by two compartment model.
Methods: according to the inclusion, exclusion criteria, were included in the study of non OSAHS control group (Non-OS AHS) of 27 subjects, 32 cases of OSAHS patients. All subjects record the basic information, the Epworth sleepiness scale (ESS) score, and routine pulmonary function test and at the same time (20:00-21:00) of the segmented breath the gas nitric oxide measurement. All OSAHS were recorded by sleep related indicators were analyzed by SPSS19.0. monitoring.
Results: compared with the Non-OSAHS group, we found that in patients with OSAHS (1): FeNO (50ml/s) and J'awNO were significantly increased, FeNO (50ml/s) and apnea hypopnea index (AHI), average nighttime oxygen saturation (Sa02), the percentage of SaO290% was significantly related to total nocturnal sleep time and night time SaO290% the total sleep time; J'awNO and AHI, Sa0290% at night sleep time, sleep time and night Sa0290% percentage of total sleep time has significant correlation; (2) CANO decreased slightly, no correlation with multichannel sleep related indicators monitoring; (3) FeNO (50ml/s), J'awNO and CANO showed no ESS the score is associated.
Conclusion: OSAHS airway (respiratory gas Department) inflammation, increased oxidative stress, and the severity of.CANO and a decrease in disease may be related to hypoxia, inflammation induced endothelial dysfunction and its potential mechanism also depends on the further study. The OSAHS patients were measured sections of exhaled nitric oxide, disease the mechanism and disease monitoring to provide help for understanding.
The effect and significance of the third part of the nasal continuous positive airway pressure ventilation on the segmented exhaled nitric oxide in severe OSAHS patients
Objective: To explore the effect and potential clinical significance of transnasal continuous positive airway pressure (nCPAP) therapy on the level of sectional exhaled nitric oxide (no) in severe OSAHS patients.
Methods: according to the inclusion, exclusion criteria, the study included 3 consecutive nights to accept CPAP treatment of patients with severe OSAHS. 30 cases were recorded in each of the basic information, and nCPAP before treatment (night), (after the morning) were measured sections of exhaled nitric oxide; collecting vein before and after treatment blood plasma -1 (ET-1) concentration; and before and after treatment for echocardiography right ventricular function evaluation were analyzed by SPSS19.0..
Results: all subjects underwent a segment of exhaled nitric oxide was measured before and after nCPAP treatment; 20 subjects agreed to before and after the treatment of venous blood collection, the determination of plasma ET-1 concentration; 22 subjects agreed to echocardiography right ventricular function evaluation; 13 subjects received treatment before and after complete heart ultrasound. Results showed that: (1) FeNO (50ml/s), J'awNO after nCPAP treatment were significantly decreased; CANO increased significantly; (2) comparison before and after treatment and changes of plasma ET-1 concentration was found for 3 consecutive nights, nCPAP treatment can significantly reduce its concentration, consistent with changes in patients with OSAHS and CANO the plasma level of ET-1 and the trend of change, but the extent is not relevant; (3) nCPAP treatment can improve right ventricular function, reduce the work, performance for the Tei index decreased, while the Tei index and plasma ET-1 concentration between Significant positive correlation.
Conclusion: the segmentation of exhaled nitric oxide detection can reflect the inflammation in the lungs of patients with severe OSAHS, oxidative stress, vasoactive substances, endothelial injury and dysfunction, pulmonary vascular resistance and right heart function changes, to improve the result of OSAHS may lead to long-term cardiovascular events may have important reference value for clinical treatment contributes to the disease. Monitoring and follow-up.

【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2013
【分類號】：R766

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本文編號：1564539