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. 2023 Aug 20;43(8):1410-1416.
doi: 10.12122/j.issn.1673-4254.2023.08.19.

[Alveolar nitric oxide concentration has a potential value in the diagnosis and differential diagnosis of interstitial lung diseases]

[Article in Chinese]
X Chang  1   2 , M Chen  1   2 , H Liao  1 , H Dong  1 , S Cai  1
Affiliations

[Alveolar nitric oxide concentration has a potential value in the diagnosis and differential diagnosis of interstitial lung diseases]

[Article in Chinese]
X Chang et al. Nan Fang Yi Ke Da Xue Xue Bao. .

Abstract
in English, Chinese

Objective: To investigate the value of exhaled nitric oxide (eNO) in the diagnosis and differential diagnosis of interstitial lung disease (ILD).

Methods: This study was conducted among 45 patients with interstitial lung disease, including 18 with connective tissue disease-related ILD (CTD-ILD) and 27 with non-CTD-ILD, with 68 healthy subjects as the control group. According to European Respiratory Association Guidelines, alveolar nitric oxide (CaNO) concentration and fractional exhaled nitric oxide (FeNO) level were measured at the flow rates of 50 and 200 mL/s. The predictive level of CaNO was analyzed using receiver-operating characteristic curve (ROC), and the correlations between CaNO and pulmonary function indicators were examined in the patients with ILD.

Results: CaNO, FeNO50, and FeNO200 levels were significantly higher in patients with ILD than in the healthy controls. Logistic regression analysis showed that lowered levels of CaNO and FeNO200 were risk factors for ILD. ROC curve analysis showed that the area under the curve (AUC) of CaNO combined with FeNO200 was 0.829 (95% CI: 0.752-0.906) for the diagnosis of ILD. In patients with ILD, CaNO levels were negatively correlated with DLCO%pred (r=-0.471, P < 0.05). Subgroup comparison showed a significantly higher CaNO level in CTD-ILD group than in non-CTD-ILD group. The AUC for CaNO to discriminate CTD-ILD from non-CTD-ILD was 0.725 (95% CI: 0.576 to 0.875).

Conclusion: CaNO has a potential value in the diagnosis of ILD and differential diagnosis of CTD-ILD.

目的: 探讨呼出气一氧化氮(eNO)在间质肺疾病诊断及鉴别诊断中的应用价值。

方法: 根据欧洲呼吸学会关于eNO的指南，收集68例健康者和45例间质性肺疾病(ILD)患者，其中包括18例结缔组织相关间质性肺疾病(CTD-ILD)，27例非结缔组织相关间质性肺疾病(non CTD-ILD)，在流速50 mL/s和200 mL/s时检测呼出气一氧化氮(FeNO)值和肺泡一氧化氮(CaNO)值，比较组间及亚组间eNO差异，应用受试者工作特征曲线(ROC)分析eNO的预测价值。并在ILD组探索CaNO与肺功能指标的相关性。

结果: ILD组CaNO、FeNO50、FeNO200水平高于健康对照组(P < 0.05)；Logistic回归分析显示CaNO和FeNO200是发生ILD的危险因素；ROC曲线分析显示CaNO和FeNO200联合诊断ILD的曲线下面积为0.829(95% CI：0.752~0.906)。在ILD组中，CaNO水平与肺一氧化碳弥散量占预计值的百分比呈负相关(r=-0.471，P < 0.05)。ILD组中分组比较显示CTD-ILD组CaNO值明显高于非CTD-ILD组(P < 0.05)。ROC曲线分析显示CaNO鉴别CTD-ILD和非CTD-ILD曲线下面积为0.725(95% CI：0.576~0.875)。

结论: CaNO在诊断ILD和鉴别CTD-ILD方面具有一定的价值。

Keywords: concentration of alveolar nitric oxide; connective tissue disease related interstitial lung disease; fraction of exhaled nitric oxide; interstitial lung disease.

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Figures

图 1
图 1
eNO参数FeNO50、FeNO200和CaNO在健康组(n=68)和ILD组(n=45)中的比较 Comparison of eNO levels between healthy control subjects (n=68) and ILD patients (n=45). *P < 0.05.
图 2
图 2
基于Logistic回归模型的ROC曲线 ROC curve based on the logistic regression model.
图 3
图 3
ILD患者中CaNO与DLCO%pred相关性分析 Correlation analysis between CaNO and DLCO% pred in ILD patients.
图 4
图 4
eNO参数FeNO50、FeNO200和CaNO在CTD-ILD组(n=18)和非CTD-ILD组(n=27)的比较 Comparison of eNO levels between CTD- ILD patients (n=18) and non-CTD-ILD (n=27).
图 5
图 5
CaNO鉴别CTD-ILD分型和非CTD-ILD分型的ROC曲线 ROC curve of CaNO for differential diagnosis between CTD-ILD and non-CTD-ILD.
See this image and copyright information in PMC

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