Jin-A Park, Hyunkyung Cha, Seung Koo Yang, Hyun Tae Ryu, Do Won Kim, Seung-No Hong, Min Suk Yang, Dae Woo Kim
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FeNO levels, the blood eosinophil percentage, total IgE, spirometry tests (FEV1/FVC), Lund-Mackay CT score, and percentage of patients with comorbid asthma were compared among CRSwNP subgroups. Spearman rank correlation test was used to assess the degree of association between variables. ROC curve analysis was conducted to evaluate the diagnostic capability to differentiate T2-CRSwNP based on clinical and histological classifications.</p><p><strong>Results: </strong>FeNO levels and the blood eosinophil percentage were significantly higher in patients with T2-CRSwNP(h) based on histological data (<i>P</i> < .05). FeNO was correlated with the blood eosinophil percentage (<i>r</i> = 0.420, <i>P</i> < .001) and FEV1/FVC (<i>r</i> = -0.324, <i>P</i> = .001). A FeNO level of 27 ppb had a good ability to discriminate patients with asthmatic T2-CRSwNP(h) (AUC = 0.848; 95% CI = 0.7602-0.9361; sensitivity = 90.9%; specificity = 63.9%). The optimal cutoff values for FeNO and the blood eosinophil percentage for diagnosing asthmatic T2-CRSwNP(h) were 68 ppb and 5.6% (sensitivity = 95.5%; specificity = 86.1%; AUC = 0.931; 95% CI = 0.8832-0.9791). In the diagnosis of severe T2-CRSwNP(c) based on clinical data, a FeNO level of 36 ppb showed the highest AUC (0.816; 95% CI = 0.7173-0.914; sensitivity = 72.7%; specificity = 79.2%).</p><p><strong>Conclusion: </strong>FeNO is a useful marker for screening asthmatic T2-CRSwNP even prior to biopsy or asthma evaluation and may assist in selecting a proper treatment.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps.\",\"authors\":\"Jin-A Park, Hyunkyung Cha, Seung Koo Yang, Hyun Tae Ryu, Do Won Kim, Seung-No Hong, Min Suk Yang, Dae Woo Kim\",\"doi\":\"10.1177/19458924231173205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fractional exhaled nitric oxide (FeNO) is useful in the management of asthma and predicting the efficacy of standard corticosteroids and biologics. However, the diagnostic value of FeNO in asthmatic chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear.</p><p><strong>Objective: </strong>We assessed FeNO levels in patients with CRSwNP and evaluated the diagnostic value of FeNO for screening type 2 CRSwNP (T2-CRSwNP) with asthma.</p><p><strong>Methods: </strong>We enrolled 94 patients who were diagnosed with CRSwNP and underwent functional endoscopic sinus surgery. FeNO levels, the blood eosinophil percentage, total IgE, spirometry tests (FEV1/FVC), Lund-Mackay CT score, and percentage of patients with comorbid asthma were compared among CRSwNP subgroups. Spearman rank correlation test was used to assess the degree of association between variables. ROC curve analysis was conducted to evaluate the diagnostic capability to differentiate T2-CRSwNP based on clinical and histological classifications.</p><p><strong>Results: </strong>FeNO levels and the blood eosinophil percentage were significantly higher in patients with T2-CRSwNP(h) based on histological data (<i>P</i> < .05). FeNO was correlated with the blood eosinophil percentage (<i>r</i> = 0.420, <i>P</i> < .001) and FEV1/FVC (<i>r</i> = -0.324, <i>P</i> = .001). A FeNO level of 27 ppb had a good ability to discriminate patients with asthmatic T2-CRSwNP(h) (AUC = 0.848; 95% CI = 0.7602-0.9361; sensitivity = 90.9%; specificity = 63.9%). The optimal cutoff values for FeNO and the blood eosinophil percentage for diagnosing asthmatic T2-CRSwNP(h) were 68 ppb and 5.6% (sensitivity = 95.5%; specificity = 86.1%; AUC = 0.931; 95% CI = 0.8832-0.9791). 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引用次数: 2
摘要
背景:呼气一氧化氮分数(FeNO)在哮喘治疗和预测标准皮质类固醇和生物制剂的疗效方面是有用的。然而，FeNO在哮喘性慢性鼻窦炎伴鼻息肉(CRSwNP)中的诊断价值尚不清楚。目的:评估CRSwNP患者的FeNO水平，评估FeNO在筛查2型CRSwNP (T2-CRSwNP)合并哮喘中的诊断价值。方法:我们招募了94例诊断为CRSwNP并接受功能性内窥镜鼻窦手术的患者。比较CRSwNP亚组间的FeNO水平、血嗜酸性粒细胞百分比、总IgE、肺活量测定(FEV1/FVC)、Lund-Mackay CT评分和合并哮喘患者比例。采用Spearman秩相关检验评估变量间的关联程度。采用ROC曲线分析，评价基于临床和组织学分类区分T2-CRSwNP的诊断能力。结果:组织学资料显示T2-CRSwNP(h)患者的FeNO水平和血嗜酸性粒细胞百分比显著升高(P r = 0.420, P r = -0.324, P = 0.001)。27 ppb的FeNO水平对哮喘型T2-CRSwNP(h)有较好的鉴别能力(AUC = 0.848;95% ci = 0.7602-0.9361;灵敏度= 90.9%;特异性= 63.9%)。诊断哮喘t2crswnp (h)的最佳临界值FeNO和血嗜酸性粒细胞百分比分别为68 ppb和5.6%(敏感性= 95.5%;特异性= 86.1%;auc = 0.931;95% ci = 0.8832-0.9791)。根据临床资料诊断严重T2-CRSwNP(c)时，FeNO水平为36 ppb时AUC最高(0.816;95% ci = 0.7173-0.914;灵敏度= 72.7%;特异性= 79.2%)。结论:FeNO是筛查哮喘t2crswnp的有效标志物，甚至在活检或哮喘评估之前，可以帮助选择适当的治疗方法。
The Role of Fractional Exhaled Nitric Oxide in Diagnosing Asthmatic Type 2 Chronic Rhinosinusitis With Nasal Polyps.
Background: Fractional exhaled nitric oxide (FeNO) is useful in the management of asthma and predicting the efficacy of standard corticosteroids and biologics. However, the diagnostic value of FeNO in asthmatic chronic rhinosinusitis with nasal polyps (CRSwNP) remains unclear.
Objective: We assessed FeNO levels in patients with CRSwNP and evaluated the diagnostic value of FeNO for screening type 2 CRSwNP (T2-CRSwNP) with asthma.
Methods: We enrolled 94 patients who were diagnosed with CRSwNP and underwent functional endoscopic sinus surgery. FeNO levels, the blood eosinophil percentage, total IgE, spirometry tests (FEV1/FVC), Lund-Mackay CT score, and percentage of patients with comorbid asthma were compared among CRSwNP subgroups. Spearman rank correlation test was used to assess the degree of association between variables. ROC curve analysis was conducted to evaluate the diagnostic capability to differentiate T2-CRSwNP based on clinical and histological classifications.
Results: FeNO levels and the blood eosinophil percentage were significantly higher in patients with T2-CRSwNP(h) based on histological data (P < .05). FeNO was correlated with the blood eosinophil percentage (r = 0.420, P < .001) and FEV1/FVC (r = -0.324, P = .001). A FeNO level of 27 ppb had a good ability to discriminate patients with asthmatic T2-CRSwNP(h) (AUC = 0.848; 95% CI = 0.7602-0.9361; sensitivity = 90.9%; specificity = 63.9%). The optimal cutoff values for FeNO and the blood eosinophil percentage for diagnosing asthmatic T2-CRSwNP(h) were 68 ppb and 5.6% (sensitivity = 95.5%; specificity = 86.1%; AUC = 0.931; 95% CI = 0.8832-0.9791). In the diagnosis of severe T2-CRSwNP(c) based on clinical data, a FeNO level of 36 ppb showed the highest AUC (0.816; 95% CI = 0.7173-0.914; sensitivity = 72.7%; specificity = 79.2%).
Conclusion: FeNO is a useful marker for screening asthmatic T2-CRSwNP even prior to biopsy or asthma evaluation and may assist in selecting a proper treatment.
期刊介绍：
The American Journal of Rhinology & Allergy is a peer-reviewed, scientific publication committed to expanding knowledge and publishing the best clinical and basic research within the fields of Rhinology & Allergy. Its focus is to publish information which contributes to improved quality of care for patients with nasal and sinus disorders. Its primary readership consists of otolaryngologists, allergists, and plastic surgeons. Published material includes peer-reviewed original research, clinical trials, and review articles.
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