Kwa zaka zambiri, mayeso a Fractional Exhaled Nitric Oxide (FeNO) akhala ngati mnzake wofunika kwambiri mu chida cha dokotala wa mphumu, makamaka kutsogolera zisankho zoyang'anira. Kusintha kwa 2025 ku malangizo a Global Initiative for Asthma (GINA) kukuwonetsa kusintha kwakukulu, kukulitsa udindo wa FeNO kupitirira kuwunika ndi kasamalidwe kuti tsopano kuthandizire mwachangu kuzindikira mphumu yotupa ya Mtundu 2 (T2). Kusintha kumeneku kumavomereza udindo waukulu wa phenotyping mu chisamaliro chamakono cha mphumu ndipo kumapereka njira yolondola kwambiri, yozikidwa pa zamoyo pozindikira koyamba.
FeNO: Kutsegula kwa Kutupa kwa Mpweya
FeNO imayesa kuchuluka kwa nitric oxide mu mpweya wotuluka, womwe umagwira ntchito ngati chizindikiro chodziwikiratu, chosavulaza cha kutupa kwa eosinophilic, kapena T2, mumsewu. Kutupa kumeneku, komwe kumayendetsedwa ndi ma cytokines monga interleukin-4, -5, ndi -13, kumadziwika ndi kuchuluka kwa IgE, ma eosinophils m'magazi ndi mkodzo, komanso kuyankha kwa corticosteroids. Mwachikhalidwe, FeNO yakhala ikugwiritsidwa ntchito ku:
Loserani momwe mankhwala opangidwa ndi corticosteroids (ICS) amayankhira: Kuchuluka kwa FeNO m'thupi kumasonyeza kuti munthu angapindule kwambiri ndi mankhwala a ICS.
Yang'anirani kutsatira ndi kuwongolera kutupa: Kuyeza motsatizana kumatha kuwunika momwe wodwalayo amatsatira chithandizo chotsutsana ndi kutupa komanso kuletsa kutupa kwa T2 komwe kumayambira.
Malangizo pa kusintha kwa chithandizo: Zochitika za FeNO zimatha kukuthandizani kusankha njira zowonjezerera kapena kuchepetsa mlingo wa ICS.
Kusintha kwa 2025: FeNO mu Njira Yodziwira
Kupita patsogolo kwakukulu mu lipoti la GINA la 2025 ndi kuvomerezedwa kwa FeNO ngati chithandizo chodziwira matenda a mphumu ya T2-high pofika nthawi yowonekera. Izi ndizofunikira kwambiri pankhani ya mawonetseredwe osiyanasiyana a mphumu.
Kusiyanitsa Mitundu ya Mphumu: Si matenda onse a kupuma movutikira kapena kupuma omwe ndi matenda a mphumu a T2. Odwala omwe ali ndi kutupa kosakhala kwa T2 kapena pauci-granulocytic amatha kukhala ndi zizindikiro zofanana koma ali ndi milingo yochepa ya FeNO. Mlingo wa FeNO wokwera nthawi zonse (monga >35-40 ppb mwa akuluakulu) mwa wodwala yemwe ali ndi zizindikiro zosonyeza kuti ali ndi chifuwa chachikulu (kutsokomola, kupuma movutikira, kuchepa kwa mpweya wosiyanasiyana) tsopano ukupereka umboni wabwino wa endotype ya T2-high, ngakhale asanayambe kulandira chithandizo.
Kuthandiza Kuzindikira Matenda Pazochitika Zovuta: Kwa odwala omwe ali ndi zizindikiro zosazolowereka kapena komwe zotsatira za spirometry sizimveka bwino kapena sizachilendo panthawi yoyezetsa, FeNO yokwera ikhoza kukhala umboni wofunikira kwambiri womwe umasonyeza kutupa kwa T2. Zimathandiza kusuntha matendawa kuchokera ku zizindikiro zosinthika kupita ku zizindikiro zamoyo.
Kudziwitsa Njira Yoyambira Yochizira Matenda: Mwa kuphatikiza FeNO pagawo lodziwira matenda, asing'anga amatha kugawa chithandizocho m'magulu mwanzeru kuyambira pachiyambi. Mlingo wapamwamba wa FeNO sumangothandiza kuzindikira matenda a mphumu komanso umaneneratu mwamphamvu momwe chithandizo cha ICS chidzayankhidwira bwino. Izi zimathandiza njira yochizira "yoyenera nthawi yoyamba" yomwe ingagwiritsidwe ntchito payekha, zomwe zingawongolere kuwongolera koyambirira ndi zotsatira zake.
Zotsatira Zachipatala ndi Kuphatikizana
Malangizo a 2025 amalimbikitsa kuphatikiza mayeso a FeNO mu kafukufuku woyamba wozindikira matenda ngati pali kukayikira kwa mphumu ndipo mwayi wopeza mayesowo ulipo. Kutanthauzira kumatsatira chitsanzo chogawanika:
High FeNO (>50 ppb mwa akuluakulu): Imathandizira kwambiri kuzindikira matenda a mphumu ya T2-high ndipo imaneneratu momwe ICS ingayankhire.
FeNO yapakati (25-50 ppb mwa akuluakulu): Iyenera kutanthauziridwa malinga ndi momwe matenda amakhalira; ikhoza kusonyeza kutupa kwa T2 koma ikhoza kukhudzidwa ndi atopy, kupezeka kwa allergen posachedwapa, kapena zinthu zina.
Low FeNO (<25 ppb mwa akuluakulu): Amachepetsa kutupa kwa T2-high, zomwe zimapangitsa kuti pakhale kuganizira za matenda ena (monga kulephera kugwira ntchito kwa mawu, matenda a mphumu omwe si a T2, COPD) kapena zifukwa zosayambitsa kutupa kwa zizindikiro.
Kusintha kumeneku sikupangitsa FeNO kukhala mayeso odziyimira pawokha koma kumaiika ngati yowonjezera yamphamvu ku mbiri yachipatala, mawonekedwe a zizindikiro, ndi mayeso a spirometry/reversibility. Kumawonjezera gawo la kusayang'ana bwino lomwe limakonza chidaliro cha matenda.
Mapeto
Malangizo a GINA a 2025 akuyimira kusintha kwa njira, kulimbitsa momwe mayeso a FeNO amayezedwera kuchokera ku chithandizo chothandizira kasamalidwe kupita ku chithandizo chofunikira chodziwira matenda a mphumu ya Mtundu wa 2. Mwa kupereka muyeso wachangu komanso wolondola wa kutupa kwa T2 komwe kumayambira, FeNO imapatsa mphamvu asing'anga kuti apange matenda olondola kwambiri pa nthawi yoyamba kukumana nawo. Izi zimapangitsa kuti pakhale chithandizo choyambirira cholunjika komanso chogwira mtima, chogwirizana bwino ndi cholinga chamakono cha mankhwala olondola pakusamalira mphumu. Pamene mwayi wopeza ukadaulo wa FeNO ukukulirakulira, ntchito yake pozindikira ndikuwongolera chithandizo cha mphumu ya T2-high ikuyembekezeka kukhala muyezo wa chisamaliro, pomaliza pake cholinga chake ndi kupeza zotsatira zabwino kwa odwala kudzera mu chithandizo choyambirira komanso cholondola.
Dongosolo Lowunikira Mpweya wa UBREATH (BA200) ndi chipangizo chachipatala chopangidwa ndi e-LinkCare Meditech kuti chigwirizane ndi mayeso a FeNO ndi FeCO kuti chipereke muyeso wachangu, wolondola, komanso wochuluka kuti chithandizire kuzindikira matenda monga mphumu ndi kutupa kwina kosatha kwa mpweya.
Nthawi yotumizira: Januwale-23-2026