摘要目的:探讨呼出气一氧化氮(FeNO)对稳定期慢性阻塞性肺疾病(COPD)患者未来1年急性加重风险的预测价值并评估其是否能指导吸入性糖皮质激素(ICS)的使用。方法:本研究为多中心、回顾性、观察性队列研究，研究对象为2017年1月至2021年12月湖南省与广西壮族自治区两地12家医院就诊的稳定期COPD患者，收集患者的基线资料、既往急性加重史、肺功能、FeNO、慢性阻塞性肺疾病评估测试问卷(CAT)评分、改良版英国医学研究委员会呼吸困难问卷(mMRC)评分、慢性阻塞性肺疾病控制问卷(CCQ)评分、详细治疗方案。以FeNO＝25 ppb为界，将患者分为高FeNO组和FeNO正常组。所有患者随访1年，记录患者急性加重信息。结果:共纳入825例患者，年龄(63.5±9.1)岁，FeNO的中位数为25 ppb。对825例患者进行为期1年的随访，其中发生急性加重的人数为262例(31.8%)。多因素logistic回归发现FeNO、CAT评分、戒烟以及既往急性加重病史是预测COPD患者未来1年急性加重的独立影响因素(均 P<0.05)。高FeNO是COPD患者未来1年急性加重的保护因素， OR值为0.10( P<0.001)。进一步分析发现高FeNO组患者使用ICS的比例显著高于FeNO正常组[58.8%(247/420) vs 48.6%(197/405)， P＝0.003]，在高FeNO组中，使用ICS能减少COPD未来1年急性加重发生率[8.9%(22/247) vs 15.6%(27/173)， P<0.05]，而在FeNO正常组中，使用ICS与未使用ICS的患者急性加重频率差异无统计学意义( P>0.05)。 结论:FeNO是预测COPD患者未来1年急性加重的独立因子，FeNO水平高的COPD患者可考虑联用ICS。

abstractsObjective:To explore the predictive value of exhaled nitric oxide (FeNO) for the risk of acute exacerbation in stable chronic obstructive pulmonary disease (COPD) patients over the next year and evaluate whether it can guide the use of inhaled corticosteroids (ICS).Methods:This study was a multicenter, retrospective and observational cohort study. The subjects of this study were stable COPD patients who were hospitalized in 12 hospitals in Hunan Province and Guangxi from January 2017 to December 2021. The patient′s basic Demography information, previous acute exacerbation history, pulmonary function, FeNO, chronic obstructive pulmonary disease assessment test questionnaire (CAT) score, modified British Medical Research Council dyspnea questionnaire (mMRC) score, chronic obstructive pulmonary disease control questionnaire (CCQ) score, and detailed treatment plan were collected. Based on FeNO 25 ppb, patients were divided into a high FeNO group and a normal FeNO group. All patients were followed up for 1 year and information on acute exacerbation was recorded.Results:A total of 825 patients were included, aged (63.5±9.1)years, with a median of 25 ppb of FeNO. A number of 825 patients were followed up for 1 year, of which 262(31.8%) experienced acute exacerbation. Multivariate logistic regression found that FeNO, CAT score, smoking cessation, and past history of acute exacerbation were independent factors predicting acute exacerbation in COPD patients in the next year (all P<0.05). High FeNO was a protective factor for acute exacerbation in COPD patients in the next year, with an OR value of 0.10 ( P<0.001). Further analysis found that the proportion of patients in the high FeNO group using ICS was significantly higher than that in the normal FeNO group [58.8%(247/420) vs 48.6%(197/405), P=0.003]. In the high FeNO group, using ICS can reduce the incidence of acute exacerbation of COPD in the next year [8.9%(22/247) vs 15.6%(27/173), P<0.05], while in the normal FeNO group, there was no statistically significant difference in the frequency of acute exacerbation between patients using ICS and those not using ICS ( P>0.05). Conclusions:FeNO is an independent factor predicting the acute exacerbation of COPD in the next year, and patients with high FeNO levels may consider using ICS in combination.