fmx_T3RoZXJNaXJyb3Jz中华医学杂志2021年10月19日第101卷第38期Natl Med J China,October
19,2021,Vol.101,No.38加重风险、气道反应性增高均有关［213?215］。FeNO低值并不能排除小气道炎症、哮喘
及激素治疗有效可能，对大小气道炎症进行联合评估，有助于诊断不同类型与不同部位气道炎症，指导不同给药方式的抗炎治疗。研究显示，CaN
O与哮喘严重程度及外周气道功能障碍密切相关，激素依赖型哮喘患者的CaNO显著高于重症哮喘及轻中度哮喘［216］。高CaNO型哮喘具
有更高的发病率和更差的哮喘控制［217］。轻度哮喘患者同样存在小气道异常，经过超微颗粒ICS治疗后哮喘控制的改善程度与基线CaNO
正相关［218］。由此可见，哮喘管理中仅单独测定FeNO是不够的，特别是激素依赖型哮喘患者存在更广泛的气道受累，应该加入CaNO测
定评估小气道炎症水平，以指导常规ICS、超微颗粒ICS或OCS的使用及针对不同气道的抗炎治疗。FeNO有助于区分COPD表型，预测
ICS疗效，而小气道和肺实质是COPD主要的炎症部位，CaNO还与COPD严重程度、小气道功能障碍及较差的体能和运动后低氧饱和度相
关［219?221］，对COPD患者进行FeNO与CaNO联合检测，可以更好地反映COPD气管和肺泡炎症水平及疾病进展，预测及评估
抗炎治疗反应。FeNO与CaNO联合检测可组合成4种类型（图5）：I型：CaNO、FeNO均正常，提示大小气道均无EOS性炎症，给
予抗炎外其他治疗；II型：CaNO正常、FeNO高，提示大气道EOS性炎症，建议常规ICS治疗；III型：CaNO、FeNO均高，
提示大小气道均存在EOS性炎症，建议超微颗粒ICS或OCS治疗；IV型：CaNO高，FeNO正常，提示小气道EOS性炎症，亦建议超
微颗粒ICS或OCS治疗。（三）FeNO与FEV1联合检测慢性气道炎症长期存在，导致气流受限的发生。FeNO监测可评估气道炎症、发
作风险及吸入激素治疗反应性，而FEV1监测则可评估气流受限、病情严重程度与控制水平。FeNO与FEV1联合检测，可克服仅依靠肺功能
结合症状诊断方法的不足，对于慢性气道疾病的诊断、炎症分型、评估控制水平及严重程度、预测治疗反应和指导治疗方案调整具有重要作用，有助
于更全面系统地评估疾病、指导疾病的管理和治疗［3］。慢性气道疾病的FeNO与FEV1联合检测可组合成4种类型（图6）：I型：FEV
1、FeNO均正常，提示经过治疗疾病稳定或轻度哮喘，可维持原治疗方案或轻度哮喘按需治疗；II型：FEV1正常、FeNO高，提示气道
EOS性炎症未控制，建议给予ICS治疗，如已规律高剂量ICS治疗，可考虑OCS或生物靶向药物加强抗炎治疗；III型：FEV1低、F
eNO高，提示存在气道EOS性炎症及气流受限，往往见于重症哮喘患者，建议ICS联合长效β2受体激动剂（LABA）及长效抗胆碱能药物
（LAMA）加强抗炎及舒张支气管治疗，必要时可考虑OCS或生物靶向药物治疗；IV型：FEV1低，FeNO正常，提示存在气流受限，如
已规律使用支气管舒张剂，建议LABA联合LAMA加强舒张支气管治疗。目前NO联合检测技术在慢性气道疾病中的具体应用还有一些争议与矛
盾，但毫无疑问，NO联合检测技术独立互补的优势使其在哮喘、COPD等气道疾病管理中的作用越来越突显。随着研究的深入及临床应用经验的
丰富，该技术会在慢性气道疾病的精准医疗与防治管理中发挥更显著的作用。五、未来研究的方向和展望应获得我国健康正常人FeNO、FnNO
、CaNO的正常值和预计值；确定诊断哮喘，包括CVA的最佳界值；开展单独应用，或是联合使用峰流速仪预测注：FeNO为呼出气一氧化氮
；CaNO为肺泡一氧化氮；ICS为吸入糖皮质激素；OCS为口服糖皮质激素图5FeNO与CaNO联合检测意义及治疗建议注：FeNO为
呼出气一氧化氮；FEV1为第1秒用力呼气容积；ICS为吸入糖皮质激素；OCS为口服糖皮质激素；LABA为长效β2受体激动剂；LAM
A为长效抗胆碱能药物图6FeNO与FEV1联合检测意义及治疗建议··3105fmx_T3RoZXJNaXJyb3Jz中华医学杂志2
021年10月19日第101卷第38期Natl Med J China,October19,2021,Vol.101,No.38哮
喘急性发作风险的研究；在常规评估哮喘控制的基础上，联合应用FeNO指导药物升降级治疗与传统策略比较降低哮喘急性发作的对比研究；上下
气道以及大小气道NO联合检测对气道不同部位炎症的分布特点以及对上下气道同时治疗和药物剂型选择的研究；小型化特别是家庭化检测仪器的研
发，真正实现应用于患者的日常管理；ACO的诊断以及预测吸入激素反应性的研究；慢性咳嗽病因诊断流程中作为激素敏感性咳嗽的重要参考指标
的研究；开展少见气道疾病如EGPA、ABPA以及EOS相关的其他气道和肺疾病的诊断、病情评估和疗效评价参考指标的研究；应用于移动终
端远程管理系统的开发研究；开展各种形式的临床医生培训活动，使其在结合临床资料的基础上对检测结果作出合理的判读，更好地指导临床实践。
起草专家（按章节先后顺序排序）：林江涛（中日友好医院）；蔡绍曦（南方医科大学南方医院）；黄茂（南京医科大学第一附属医院）；王长征（
重庆医科大学附属第三医院）；邱忠民（同济大学附属同济医院）；余莉（同济大学附属同济医院）；邱晨（深圳市人民医院）；农英（中日友好医
院）；张清玲（广州医科大学附属第一医院广州呼吸健康研究院）；吴昌归（西安国际医学中心胸科医院）主审专家（按姓氏拼音排序）：蔡柏蔷（
北京协和医院）；陈萍（北部战区总医院）；何权瀛（北京大学人民医院）；万欢英（上海交通大学医学院附属瑞金医院）；姚婉贞（北京大学第三
医院）；殷凯生（南京医科大学附属第一医院）；周新（上海交通大学附属第一人民医院）讨论专家（按姓氏拼音排序）：鲍文华（佳木斯大学附属
第一医院）；陈愉生（福建省立医院）；董亮（山东大学齐鲁医院）；杜鹃（贵州医科大学附属医院）；顾玉海（青海省人民医院）；贺蓓（北京大
学第三医院）；黄奕江（海南省肿瘤医院）；姜淑娟（山东省立医院）；孔灵菲（中国医科大学附属第一医院）；李满祥（西安交通大学第一附属医
院）；刘辉国（华中科技大学同济医学院附属同济医院）；刘荣玉（安徽医科大学第一附属医院）；刘晓民（哈尔滨医科大学第一附属医院）；彭丽
萍（吉林大学第一医院）；史利卿（北京中医药大学东方医院）；孙增涛（天津中医药大学）；唐华平（青岛市市立医院）；文富强（四川大学华西
医院）；谢华（北部战区总医院）；于文成（青岛大学附属医院）；袁雅冬（河北医科大学第二医院）；云春梅（内蒙古自治区人民医院）；张筱娴
（广州医科大学附属第一医院广州呼吸健康研究院）；赵海金（南方医科大学南方医院）；周玮（宁夏医科大学总医院）文字整理：农英（中日友好
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