工作相关性哮喘（WRA）筛查工具及其诊断准确性的系统评价
2025/07/25
摘要
背景：工作相关性哮喘 (work-related asthma: WRA)在成人哮喘患者中约占1/4，早期发现对改善患者健康及职业预后至关重要，但临床诊断常被延误。目前筛查工具的标准化和有效性尚未明确。本研究通过系统评价旨在总结比较临床和职场环境中WRA筛查工具的效能差异。
方法：研究团队检索了1975至2024年间MEDLINE、Embase等数据库及相关文献，纳入针对16岁以上人群的WRA筛查研究。由两名评审员独立筛选文献、提取数据，并采用QUADAS-2或PROBAST工具评估偏倚风险。通过配对森林图汇总各筛查工具的敏感性和特异性指标。
结果：在初步筛选的17504项研究中，最终纳入7项研究。这些研究均在三级医院（5项）和专科中心（2项）开展。筛查工具包括单独使用的问卷（单项问题3项，复合问题2项）、问卷联合乙酰甲胆碱激发试验（1项）以及诊断模型（4项）。研究发现，“脱离工作后症状改善”这一单项问题的敏感性为74%～87%，特异性为15%～58%；复合问题问卷的敏感性达80%～100%，特异性为8%～55%。其中一项研究显示，在问卷基础上增加乙酰甲胆碱激发试验可将特异性提高至75%，此时敏感性为65%。诊断模型的曲线下面积（AUC）介于0.69至0.89之间，当加入人口统计学变量或客观检查指标后，AUC值有所提升。
结论：研究表明，“脱离工作后症状改善”这一单项问题及复合问题问卷对WRA筛查具有较高敏感性但特异性较低，这已能满足初步筛查需求以促进WRA诊断。通过增加人口统计学变量和客观检查可进一步提高特异性或AUC值。然而，现有关于WRA筛查工具的研究仍较为有限且报告质量参差不齐，未来需要在基层医疗和职场人群中开展更多效能评估研究。
本研究已在PROSPERO平台注册（注册号：CRD42021246031）。
关键词：哮喘，职业性肺病，敏感性/特异性，问卷调查
文献来源：Kongsupon N,et al.Screening tools for work-related asthma and their diagnostic accuracy: a systematic review.BMJ Open Respir Res. 2025 Jul 15;12(1):e003251
Abstract
Introduction: One in four cases of asthma in adults is caused or worsened by work (work-related asthma: WRA). Early detection of WRA could prevent poor health and employment outcomes, but clinical diagnosis is often missed or delayed. The standardisation and effectiveness of screening tools have not been well established. We aimed to summarise and compare the performance of screening tools for identifying WRA in both clinical settings and workplaces.
Methods: We searched for studies that used structured questionnaires or prediction models (with/without physiological tests) to identify WRA in clinical settings or workplaces with individuals aged≥16 years in MEDLINE, Embase, other bibliographic databases and grey literature between 1975 and 2024. Two reviewers independently screened titles, abstracts and full texts for inclusion, extracted data and assessed risk of bias using QUADAS-2 tool (Quality Assessment of Diagnostic Test Accuracy 2) or PROBAST (Prediction Model Risk of Bias Assessment Tool). Screening tools and their indices of accuracy were summarised with paired forest plots of sensitivities and specificities.
Results: Of 17 504 identified studies, 7 were included. All were implemented in tertiary hospitals (n=5) and specialist centres (n=2). The screening tools comprised questionnaires alone (individual questions n=3 and multiple questions n=2), questionnaire with methacholine challenge test (n=1) and diagnostic models (n=4). The question 'improvement off work' had sensitivity=74-87% and specificity=15-58% for identifying WRA. Multiple questions had sensitivity=80-100% and specificity=8-55%. Addition of the methacholine challenge test to one questionnaire improved specificity to 75% with sensitivity=65%. Diagnostic models reported area under the curve (AUC) between 0.69 and 0.89, and AUC was improved when adding demographic variables or objective tests.
Discussion: A single item 'improvement off work' and multiple questions have high sensitivity but low specificity for WRA, which are sufficient for screening purposes to enhance WRA diagnosis. Adding demographic variables and objective tests can improve specificity or AUC. However, studies on screening tools for WRA are limited and inadequately reported; further evaluations of performance are needed in primary care populations and workplaces.
Prospero registration number: CRD42021246031.
Keywords: Asthma; Occupational Lung Disease; Sensitivity and Specificity; Surveys and Questionnaires.
背景：工作相关性哮喘 (work-related asthma: WRA)在成人哮喘患者中约占1/4，早期发现对改善患者健康及职业预后至关重要，但临床诊断常被延误。目前筛查工具的标准化和有效性尚未明确。本研究通过系统评价旨在总结比较临床和职场环境中WRA筛查工具的效能差异。
方法：研究团队检索了1975至2024年间MEDLINE、Embase等数据库及相关文献，纳入针对16岁以上人群的WRA筛查研究。由两名评审员独立筛选文献、提取数据，并采用QUADAS-2或PROBAST工具评估偏倚风险。通过配对森林图汇总各筛查工具的敏感性和特异性指标。
结果：在初步筛选的17504项研究中，最终纳入7项研究。这些研究均在三级医院（5项）和专科中心（2项）开展。筛查工具包括单独使用的问卷（单项问题3项，复合问题2项）、问卷联合乙酰甲胆碱激发试验（1项）以及诊断模型（4项）。研究发现，“脱离工作后症状改善”这一单项问题的敏感性为74%～87%，特异性为15%～58%；复合问题问卷的敏感性达80%～100%，特异性为8%～55%。其中一项研究显示，在问卷基础上增加乙酰甲胆碱激发试验可将特异性提高至75%，此时敏感性为65%。诊断模型的曲线下面积（AUC）介于0.69至0.89之间，当加入人口统计学变量或客观检查指标后，AUC值有所提升。
结论：研究表明，“脱离工作后症状改善”这一单项问题及复合问题问卷对WRA筛查具有较高敏感性但特异性较低，这已能满足初步筛查需求以促进WRA诊断。通过增加人口统计学变量和客观检查可进一步提高特异性或AUC值。然而，现有关于WRA筛查工具的研究仍较为有限且报告质量参差不齐，未来需要在基层医疗和职场人群中开展更多效能评估研究。
本研究已在PROSPERO平台注册（注册号：CRD42021246031）。
关键词：哮喘，职业性肺病，敏感性/特异性，问卷调查
文献来源：Kongsupon N,et al.Screening tools for work-related asthma and their diagnostic accuracy: a systematic review.BMJ Open Respir Res. 2025 Jul 15;12(1):e003251
（南方医科大学南方医院 欧阳文珊 赵海金）
Abstract
Introduction: One in four cases of asthma in adults is caused or worsened by work (work-related asthma: WRA). Early detection of WRA could prevent poor health and employment outcomes, but clinical diagnosis is often missed or delayed. The standardisation and effectiveness of screening tools have not been well established. We aimed to summarise and compare the performance of screening tools for identifying WRA in both clinical settings and workplaces.
Methods: We searched for studies that used structured questionnaires or prediction models (with/without physiological tests) to identify WRA in clinical settings or workplaces with individuals aged≥16 years in MEDLINE, Embase, other bibliographic databases and grey literature between 1975 and 2024. Two reviewers independently screened titles, abstracts and full texts for inclusion, extracted data and assessed risk of bias using QUADAS-2 tool (Quality Assessment of Diagnostic Test Accuracy 2) or PROBAST (Prediction Model Risk of Bias Assessment Tool). Screening tools and their indices of accuracy were summarised with paired forest plots of sensitivities and specificities.
Results: Of 17 504 identified studies, 7 were included. All were implemented in tertiary hospitals (n=5) and specialist centres (n=2). The screening tools comprised questionnaires alone (individual questions n=3 and multiple questions n=2), questionnaire with methacholine challenge test (n=1) and diagnostic models (n=4). The question 'improvement off work' had sensitivity=74-87% and specificity=15-58% for identifying WRA. Multiple questions had sensitivity=80-100% and specificity=8-55%. Addition of the methacholine challenge test to one questionnaire improved specificity to 75% with sensitivity=65%. Diagnostic models reported area under the curve (AUC) between 0.69 and 0.89, and AUC was improved when adding demographic variables or objective tests.
Discussion: A single item 'improvement off work' and multiple questions have high sensitivity but low specificity for WRA, which are sufficient for screening purposes to enhance WRA diagnosis. Adding demographic variables and objective tests can improve specificity or AUC. However, studies on screening tools for WRA are limited and inadequately reported; further evaluations of performance are needed in primary care populations and workplaces.
Prospero registration number: CRD42021246031.
Keywords: Asthma; Occupational Lung Disease; Sensitivity and Specificity; Surveys and Questionnaires.
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