• 1 四川大學(xué)華西醫(yī)院呼吸內(nèi)科（四川成都 610041）;;
  • 2 四川大學(xué)華西醫(yī)院健康體檢中心（四川成都 610041）;

目的  評(píng)價(jià)呼出氣一氧化氮( eNO) 檢測(cè)對(duì)哮喘診斷的有效性和準(zhǔn)確性 方法  采用計(jì)算機(jī)和手工檢索, 全面收集當(dāng)前研究eNO檢測(cè)用于哮喘診斷的文獻(xiàn), 并根據(jù)QUADAS 量表的評(píng)價(jià)標(biāo)準(zhǔn)對(duì)文獻(xiàn)進(jìn)行評(píng)價(jià), 用Meta-disc 軟件對(duì)可提取四格表數(shù)據(jù)的文獻(xiàn)進(jìn)行異質(zhì)性分析, 對(duì)敏感性( Sen) 、特異性( Spe) 、診斷試驗(yàn)比值比( DOR) 等結(jié)果進(jìn)行合并分析, 并繪制匯總受試者工作特征曲線( SROC) 。最后進(jìn)行敏感性分析。結(jié)果  共納入符合納入標(biāo)準(zhǔn)的文獻(xiàn)11 篇。質(zhì)量評(píng)價(jià)時(shí), 所納入的文獻(xiàn)在納入人群全部經(jīng)參考標(biāo)準(zhǔn)的確認(rèn)、使用相同的參考標(biāo)準(zhǔn)、待評(píng)價(jià)試驗(yàn)獨(dú)立于參考標(biāo)準(zhǔn)以及所有的研究對(duì)象完成了研究這四方面較好地控制了偏倚。其次在疾病進(jìn)展性偏倚發(fā)生的可能性較小,參考標(biāo)準(zhǔn)解釋可發(fā)生較大的偏倚。文獻(xiàn)的疾病譜、納入人群的標(biāo)準(zhǔn)、報(bào)告質(zhì)量的描述較差。在統(tǒng)計(jì)分析時(shí), eNO檢測(cè)診斷哮喘的總的合并Sen、Spe 分別為0. 68、0. 79, DOR 為12. 73, SROC 的曲線下面積( SAUC) 為0. 8446。納入文獻(xiàn)穩(wěn)定性好。結(jié)論  匯總目前eNO 檢測(cè)診斷哮喘的研究顯示, eNO檢測(cè)對(duì)哮喘具有一定的診斷價(jià)值, 應(yīng)以更多高質(zhì)量的研究作進(jìn)一步的分析。

引用本文： 梁斌苗,王茂筠,王佑娟,袁玉茹,馮玉麟. 呼出氣一氧化氮對(duì)哮喘診斷價(jià)值的系統(tǒng)評(píng)價(jià). 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(2): 135-140. doi: 復(fù)制

1. Braman SS. The Global Burden of Asthma. Chest, 2006, 130: 4S-12S.
2. Global Strategy for Asthma Management and Prevention: Global Initiative For Asthma( GINA) 2006. Available from: URL: http: / /www. ginasthma. org.
3. nd edition.
4. Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing-1999. Am J Respir Crit Care Med, 2000, 161: 309-329.
5. Dupont LJ, Rochette F, Demedts MG, et al. Exhaled nitric oxide correlates with airway hyperresponsiveness in steroid-naive patients with mild asthma. AmJ Respir Crit Care Med, 1998, 157: 894-898.
6. Markus B, Heiner B, Matthias E, et al. The Bayes Library of Diagnostic Studies and Reviews.
7. Salome CM, Roberts AM, Brown NJ, et al. Exhaled nitric oxide measurements in a population sample of young adults. Am J Respir Crit Care Med, 1999, 159: 911-916.
8. Chiron R, Vachier I, Godard P, et al. The measurement of exhaled nitric oxide, a new tool in the management of asthma. Presse Med, 2004, 33: 1451-1458.
9. Kharitonov SA, Gonio F, Kelly C, et al. Reproducibility of exhaled nitric oxide measurements in healthy and asthmatic adults and children. Eur Respir J, 2003, 21: 433-438.
10. Choi J, Hoffman LA, Rodway GW, et al. Markers of lung disease in exhaled breath: nitric oxide. Biol Res Nurs, 2006 , 7: 241-255 .
11. Whiting P, Ruties AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol,2003, 3: 25.
12. Zamora J, Abraira V,Muriel A, et al. Meta-DiSc: a software for metaanalysis of test accuracy data. BMC Med Res Methodol, 2006 , 6: 31 .
13. Arora R, Thornblade CE, Dauby PA, et al. Exhaled nitric oxide levels in military recruits with new onset asthma. Allergy Asthma Proc, 2006, 27: 493-498.
14. Berkman N, Avital A, Breuer R, et al. Exhaled nitric oxide in the diagnosis of asthma: comparison with bronchial provocation tests.Thorax, 2005, 60: 383-388.
15. Chatkin JM, Ansarin K, Silkoff PE, et al. Exhaled nitric oxide as a noninvasive assessment of chronic cough. Am J Respir Crit Care Med, 1999, 159: 1810-1813.
16. Miedinger D, Chhajed PN, Tamm M, et al. Diagnostic Tests for Asthma in Firefighters. Chest, 2007, 131: 1760-1767.
17. Deykin A, Massaro AF, Drazen JM, et al. Exhaled Nitric Oxide as a Diagnostic Test for Asthma Online versus Offline Techniques and Effect of Flow Rate. Am J Respir Crit Care Med, 2002, 165: 1597-1601.
18. Dupont LJ, Demedts MG, Verleden GM. Prospective Evaluation of the Validity of Exhaled Nitric Oxide for the Diagnosis of Asthma.Chest, 2003, 123: 751-756.
19. Franklin PJ, Turner SW, Le Souef PN, et al. Exhaled nitric oxide and asthma: complex interactions between atopy, airway responsiveness, and symptoms in a community population of children. Thorax, 2003, 58: 1048-1052.
20. Heffler E, Guida G, Marsico P, et al. Exhaled nitric oxide as a diagnostic test for asthma in rhinitic patients with asthmatic symptoms. Respir Med, 2006, 100: 1981-1987.
21. Malmberg LP, Pelkonen AS, Haahtela T, et al. Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma. Thorax, 2003, 58: 494-499.
22. Smith AD, Cowan JO, Filsell S, et al. Diagnosing asthma:Comparisons between Exhaled Nitric Oxide Measurements and Conventional Tests. Am J Respir Crit Care Med, 2004, 169: 473-478.
23. Thomas PS, Gibson PG, Wang H, et al. The relationship of exhaled nitric oxide to airway inflammation and responsiveness in children. J Asthma, 2005, 42: 291-295.
24. Irwig L, Macaskill P, Glasziou P, et al. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol, 1995, 48: 119-130.
25. Riedler J, Reade T, Dalton M, et al. Hypertonic saline challenge in an epidemiologic survey of asthma in children. Am J Respir Crit Care Med, 1994, 150: 1632-1639.
26. Riedler J, Reade T, Robertson CF. Repeatability of response to hypertonic saline aerosol in children with mild to severe asthma.Pediatr Pulmonol, 1994, 18: 330-336.
27. Makker HK, Holgate ST. Relation of the hypertonic saline responsiveness of the airways to exercise induced asthma symptom severity and to histamine or methacholine reactivity. Thorax, 1993 ,48: 142-147.
28. Haby MM, Anderson SD, Peat JK, et al. An exercise challenge protocol for epidemiological studies of asthma in children:comparison with histamine challenge. Eur Respir J, 1994, 7 : 43-49.
29. Kivity S, Greif J, Reisner B, et al. Bronchial inhalation challenge with ultrasonically nebulized saline; comparison to exercise-induced asthma. Ann Allergy, 1986 , 57: 355 -358.
30. ATS/ ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005. Am J Respir Crit Care Med, 2005, 171: 912-930.
31. Pijnenburg MW, Jobsis Q, de J　ngste JC. “Inflammometry” with nitric oxide in exhaled air: a new test for lung diseases [ in Dutch] .Ned Tijdschr Geneeskd, 2001, 145: 946-950.
32. .
  1. 1. Braman SS. The Global Burden of Asthma. Chest, 2006, 130: 4S-12S.
  2. 2. Global Strategy for Asthma Management and Prevention: Global Initiative For Asthma( GINA) 2006. Available from: URL: http: / /www. ginasthma. org.
  3. 3. nd edition.
  4. 4. Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing-1999. Am J Respir Crit Care Med, 2000, 161: 309-329.
  5. 5. Dupont LJ, Rochette F, Demedts MG, et al. Exhaled nitric oxide correlates with airway hyperresponsiveness in steroid-naive patients with mild asthma. AmJ Respir Crit Care Med, 1998, 157: 894-898.
  6. 6. Markus B, Heiner B, Matthias E, et al. The Bayes Library of Diagnostic Studies and Reviews.
  7. 7. Salome CM, Roberts AM, Brown NJ, et al. Exhaled nitric oxide measurements in a population sample of young adults. Am J Respir Crit Care Med, 1999, 159: 911-916.
  8. 8. Chiron R, Vachier I, Godard P, et al. The measurement of exhaled nitric oxide, a new tool in the management of asthma. Presse Med, 2004, 33: 1451-1458.
  9. 9. Kharitonov SA, Gonio F, Kelly C, et al. Reproducibility of exhaled nitric oxide measurements in healthy and asthmatic adults and children. Eur Respir J, 2003, 21: 433-438.
  10. 10. Choi J, Hoffman LA, Rodway GW, et al. Markers of lung disease in exhaled breath: nitric oxide. Biol Res Nurs, 2006 , 7: 241-255 .
  11. 11. Whiting P, Ruties AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol,2003, 3: 25.
  12. 12. Zamora J, Abraira V,Muriel A, et al. Meta-DiSc: a software for metaanalysis of test accuracy data. BMC Med Res Methodol, 2006 , 6: 31 .
  13. 13. Arora R, Thornblade CE, Dauby PA, et al. Exhaled nitric oxide levels in military recruits with new onset asthma. Allergy Asthma Proc, 2006, 27: 493-498.
  14. 14. Berkman N, Avital A, Breuer R, et al. Exhaled nitric oxide in the diagnosis of asthma: comparison with bronchial provocation tests.Thorax, 2005, 60: 383-388.
  15. 15. Chatkin JM, Ansarin K, Silkoff PE, et al. Exhaled nitric oxide as a noninvasive assessment of chronic cough. Am J Respir Crit Care Med, 1999, 159: 1810-1813.
  16. 16. Miedinger D, Chhajed PN, Tamm M, et al. Diagnostic Tests for Asthma in Firefighters. Chest, 2007, 131: 1760-1767.
  17. 17. Deykin A, Massaro AF, Drazen JM, et al. Exhaled Nitric Oxide as a Diagnostic Test for Asthma Online versus Offline Techniques and Effect of Flow Rate. Am J Respir Crit Care Med, 2002, 165: 1597-1601.
  18. 18. Dupont LJ, Demedts MG, Verleden GM. Prospective Evaluation of the Validity of Exhaled Nitric Oxide for the Diagnosis of Asthma.Chest, 2003, 123: 751-756.
  19. 19. Franklin PJ, Turner SW, Le Souef PN, et al. Exhaled nitric oxide and asthma: complex interactions between atopy, airway responsiveness, and symptoms in a community population of children. Thorax, 2003, 58: 1048-1052.
  20. 20. Heffler E, Guida G, Marsico P, et al. Exhaled nitric oxide as a diagnostic test for asthma in rhinitic patients with asthmatic symptoms. Respir Med, 2006, 100: 1981-1987.
  21. 21. Malmberg LP, Pelkonen AS, Haahtela T, et al. Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma. Thorax, 2003, 58: 494-499.
  22. 22. Smith AD, Cowan JO, Filsell S, et al. Diagnosing asthma:Comparisons between Exhaled Nitric Oxide Measurements and Conventional Tests. Am J Respir Crit Care Med, 2004, 169: 473-478.
  23. 23. Thomas PS, Gibson PG, Wang H, et al. The relationship of exhaled nitric oxide to airway inflammation and responsiveness in children. J Asthma, 2005, 42: 291-295.
  24. 24. Irwig L, Macaskill P, Glasziou P, et al. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol, 1995, 48: 119-130.
  25. 25. Riedler J, Reade T, Dalton M, et al. Hypertonic saline challenge in an epidemiologic survey of asthma in children. Am J Respir Crit Care Med, 1994, 150: 1632-1639.
  26. 26. Riedler J, Reade T, Robertson CF. Repeatability of response to hypertonic saline aerosol in children with mild to severe asthma.Pediatr Pulmonol, 1994, 18: 330-336.
  27. 27. Makker HK, Holgate ST. Relation of the hypertonic saline responsiveness of the airways to exercise induced asthma symptom severity and to histamine or methacholine reactivity. Thorax, 1993 ,48: 142-147.
  28. 28. Haby MM, Anderson SD, Peat JK, et al. An exercise challenge protocol for epidemiological studies of asthma in children:comparison with histamine challenge. Eur Respir J, 1994, 7 : 43-49.
  29. 29. Kivity S, Greif J, Reisner B, et al. Bronchial inhalation challenge with ultrasonically nebulized saline; comparison to exercise-induced asthma. Ann Allergy, 1986 , 57: 355 -358.
  30. 30. ATS/ ERS Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide, 2005. Am J Respir Crit Care Med, 2005, 171: 912-930.
  31. 31. Pijnenburg MW, Jobsis Q, de J　ngste JC. “Inflammometry” with nitric oxide in exhaled air: a new test for lung diseases [ in Dutch] .Ned Tijdschr Geneeskd, 2001, 145: 946-950.
  32. 32. .

  • 上一篇

    GRADE：什么是“證據(jù)質(zhì)量”？ 為什么它對(duì)臨床醫(yī)生重要？

  • 下一篇

    推動(dòng)我國循證醫(yī)學(xué)發(fā)展的策略和措施——循證醫(yī)學(xué)教育部網(wǎng)上合作研究中心/ 中國循證醫(yī)學(xué)中心2008年度工作會(huì)議紀(jì)要