吸入甘露醇在哮喘诊断上的特征：一项人口学研究
2009/10/15
背景：近期临床上引入了一项新的检测气道反应性的试验，即吸入性甘露醇间接支气管激发试验。
目的：在一个非选择性的年轻成人样本中进行哮喘评估，评价吸入性甘露醇对气道反应性的诊断特征。
方法：从全国公民登记簿中随机挑选238例年轻成人，进行吸入性甘露醇干粉激发试验。根据其哮喘表现情况，即：呼吸道症状、肺活量测定结果、特应性和呼气中一氧化氮分数以及对吸入性β2受体激动剂的反应特点，呼吸科专家（对检测结果不知情）将该238例受试者进行分组。并在此基础上评估不同试验敏感性、特异性和预测值的截断值。绘制受试者操作特征曲线（定义为曲线下面积），并计算该试验的精确度。
结果：51例（21.4%）受试者为现患哮喘。33例患者的甘露醇激发试验呈高反应性，其中30例为现患哮喘。诊断的特异性和敏感性分别为98.4% (95%CI 96.2～99.4%)和58.8% (95%CI 50.7～62.6%)。阳性预测值（PPV）和阴性预测值（NPV）分别为90.9% (95% CI 78.4～96.8%)和89.8 (95% CI 87.7～90.7%)。受试者操作特征曲线的曲线下面积为0.89 (95% CI 0.83～0.95)。
结论：此项在非选择性成人样本中进行的研究结果显示，吸入性甘露醇干粉支气管激发试验对哮喘的诊断具有较高的特异性。
（苏楠 审校）
Sverrild A, et al. J Allergy Clin Immunol. 2009 Aug 7.
Diagnostic properties of inhaled mannitol in the diagnosis of asthma: A population study.
Sverrild A, Porsbjerg C, Thomsen SF, Backer V.
BACKGROUND: A new indirect bronchial provocation test measuring airway responsiveness by using inhaled mannitol was recently introduced.
OBJECTIVE: The aim of this study was to examine the diagnostic properties of airway responsiveness to inhaled mannitol in the assessment of asthma in an unselected sample of young adults.
METHODS: Two hundred thirty-eight young adults randomly drawn from the nationwide civil registration list were challenged with inhaled, dry-powder mannitol. A respiratory specialist, blind to the test results, classified all 238 subjects with respect to the presence of asthma. The classification was based on respiratory symptoms, spirometric results, atopy, and fraction of exhaled nitric oxide values and response to inhaled beta(2)-agonists. On this basis, sensitivity, specificity, and predictive values were assessed to different cutoff values of the test. A receiver operating characteristic curve was constructed, and the accuracy of the test, defined as the area under the curve, was computed.
RESULTS: Fifty-one (21.4%) subjects had current asthma. Of 33 subjects with airway hyperresponsiveness to mannitol, 30 had current asthma. The specificity and sensitivity were 98.4% (95% CI, 96.2% to 99.4%) and 58.8% (95% CI, 50.7% to 62.6%), respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 90.9% (95% CI, 78.4% to 96.8%) and 89.8 (95% CI, 87.7% to 90.7%), respectively. The area under the receiver operating characteristic curve was 0.89 (95% CI, 0.83-0.95).
CONCLUSIONS: In an unselected sample of young adults, bronchial provocation with inhaled dry-powder mannitol had a high diagnostic specificity for the diagnosis of asthma.
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学龄前儿童的哮喘提示症状对长期预后的预测作用
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3分钟呼吸运动试验对呼吸困难的感知可预测哮喘加重：前瞻性队列研究
