Background

Nasal nitric oxide (nNO) is considered a biomarker of nasal inflammation.

Objective

To perform a systematic review with meta-analysis and meta-regressions on the association between nNO levels and allergic rhinitis (AR).

Methods

PubMed, Web of Science, Scopus, and EMBASE databases were systematically searched. Differences between cases and controls were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI).

Results

Overall, 39 articles were included: 30 containing data on nNO measured by nasal aspiration (1881 patients with AR and 1337 controls) and 12 assessing nNO by nasal exhalation (525 patients with AR and 350 controls). Compared with controls, AR presented significantly higher nNO values both during nasal aspiration (SMD, 1.309; 95% CI, 0.841-1.777; P < .001) and nasal exhalation (SMD, 0.708; 95% CI, 0.303-1.114; P = .001). Sensitivity and subgroup analyses confirmed that the results for the evaluated outcomes were not affected by the presence of clinical confounding factors (asthma, nasal polyps, inhaled corticosteroids, smoking history), this being valid for both perennial and seasonal diseases during exposure to allergens. For the aspiration method, meta-regressions indicated that older age and a better pulmonary function were associated with a lower difference in nNO levels between patients with AR and controls, whereas an increasing aspiration flow was associated with a high effect size.

Conclusion

nNO levels are higher in AR, particularly when using high aspiration flows and in younger patients, who often perceive this condition as a source of disability. Further studies are needed to evaluate the usefulness of this biomarker for monitoring airway disorders and optimizing strategies in different settings (community, hospital, rehabilitation).

中文翻译：

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鼻一氧化氮在变应性鼻炎中的临床应用：系统评价和荟萃分析。

背景

鼻腔一氧化氮（nNO）被认为是鼻腔炎症的生物标记。

目的

对nNO水平与变应性鼻炎（AR）之间的关联进行荟萃分析和荟萃回归，进行系统评价。

方法

系统搜索了PubMed，Web of Science，Scopus和EMBASE数据库。病例与对照之间的差异表示为标准平均差异（SMD），置信区间（CI）为95％。

结果

总的来说，共包括39篇文章：30篇包含通过鼻腔抽吸测量的nNO数据（1881例AR和1337例对照）和12篇通过鼻呼气评估nNO的数据（525例AR和350例对照）。与对照组相比，AR呈现显著更高NNO值两者鼻抽吸期间（SMD，1.309; 95％CI，0.841-1.777; P <.001）和鼻呼气（SMD，0.708; 95％CI，0.303-1.114; P = .001）。敏感性和亚组分析证实，评估结果的结果不受临床混杂因素（哮喘，鼻息肉，吸入皮质类固醇，吸烟史）的影响，这对于暴露于变应原期间的多年生和季节性疾病均有效。对于抽吸方法，Meta回归分析表明，AR患者与对照组之间，nNO水平的降低与年龄的增长和肺功能的改善有关，而抽吸流量的增加与效应量的增加相关。

结论

AR中的nNO水平较高，尤其是在使用大量抽吸流量时，以及年轻的患者中，他们通常将这种情况视为残疾的来源。需要进一步的研究来评估这种生物标志物在监测气道疾病和优化不同环境（社区，医院，康复）中的策略的有用性。