职业性哮喘的一项新的诊断评分标准——日间工作状态与非工作时最大呼气流量的曲线间面积（ABC评分）
2009/05/18
循证指南推荐将日间工作时和非公作时PEF的系列测定作为职业性哮喘的客观认证的第一步。基于目前指南针对症状性职业性哮喘的客观最初评价是通过PEF昼夜变异率的检测获得。为提高诊断水平，Vicky C. Moore等人采用计算机技术，应用办公自动化软件Oasys-2对日间工作时与非工作时PEF的曲线间面积（ABC）进行评分。
本研究纳入了109个职业性哮喘患者和117个对照哮喘患者，在日间工作时与非工作时每2小时测1次PEF值。被计算机分析的两组数据中包括有≥4个白班，≥4个休息日，每天≥6次读数。患者随机分到两个数据库中。ROC曲线分析可确定某一截点可在数据库1中最好的识别职业性哮喘。
逻辑回归分析显示所有的ABC –PEF评分对职业性哮喘患者有很好的预测性，从清醒后每1小时的ABC均为最佳值。（似然比，11.9/10 L/h/min;95%可信区间，10.8:13.1）。ROC曲线分析显示在诊断职业性哮喘方面，15 L/min/h的差异有比较高的特异性，且敏感性不受影响。从数据库2的数据分析显示其特异性100%，敏感性72%。该研究提出ABC-PEF评分对于诊断职业性哮喘具有敏感性和特异性，且对于目前的办公自动化系统的参数所需要的PEF值而言，该评分仅需较短时间的PEF监测即可获得。
（于娜 中国医科大学附属第一医院呼吸科 110001 摘译）
（Chest February 2009 135:307-314; doi:10.1378/chest.08-0778）
A New Diagnostic Score for Occupational AsthmaThe Area Between the Curves (ABC Score) of Peak Expiratory Flow on Days at and Away From Work
Vicky C. Moore, MS*,
Maritta S. Jaakkola, MD,
Cedd B. S. G. Burge, MS,
Charles F. A. Pantin, MD,
Arun Dev Vellore, MD and
Abstract
Background: Evidence-based guidelines recommend serial measurements of peak expiratory flow (PEF) on days at and away from work as the first step in the objective confirmation of occupational asthma. The aim of this study was to improve the diagnostic value of computer-based PEF analysis by using the program Oasys-2 to calculate a score from the area between the curves (ABC) of PEF on days at and away from work.
Methods: Mean 2-hourly PEFs were plotted separately for workdays and rest days for 109 workers with occupational asthma and 117 control asthmatics. A score based on the ABC was computed from records containing ≥ 4 day shifts, ≥ 4 rest days, and ≥ 6 readings per day. Patients were randomly classified into two data sets (analysis and test sets). Receiver operator characteristic (ROC) curve analysis determined a cutoff point from set 1 that best identified those with occupational asthma, which was then tested in set 2.
Logistic regression analysis showed that all ABC PEF scores were significant predictors of occupational asthma, with the best being ABC per hour from waking (odds ratio, 11.9 per 10 L/h/min; 95% confidence interval, 10.8 to 13.1). ROC curve analysis showed that a difference of 15 L/min/h provided a high specificity without compromising sensitivity in diagnosing occupational asthma. Analysis of data set 2 confirmed a specificity of 100% and sensitivity of 72%.
Conclusion: The ABC PEF score is sensitive and specific for the diagnosis of occupational asthma and can be calculated from a shorter PEF surveillance than is needed for the current Oasys-2 work effect index.
