等二氧化碳自主过度通气法在诊断运动诱发支气管痉挛的临床应用
2009/11/16
背景：运动诱发性支气管痉挛（EIB）是与运动相关的急性、暂时性气道狭窄。等二氧化碳自主过度通气法（EVH）已经在选拔优秀运动员和一些研究机构中用于诊断EIB。但EVH 在临床呼吸科的应用未见报道。本试验研究EVH的临床应用价值。
方法：我们对俄亥俄州州立大学医学中心的178次EVH检测进行回顾性研究。
结果：共进行了178次EVH检测。55例患者（28%）EIB阳性。将每分钟最大自主通气预测值（MVV）的60％作为EVH完全检测的标准。大部分患者（127名，71％）进行EVH完全检测。女性患者达到60％MVV的可能性小于男性（80% vs. 55%; p = 0.002）。对于51例未完全检测的患者，17例（33％）为阳性，其中的16例为女性患者。总体而言，EVH检测在178例患者中检测出144例阳性患者（81%）。
结论：本研究首次在临床呼吸科应用EVH诊断EIB。EVH对大部分患者具有诊断价值。在临床呼吸科，EVH是一种较好的、可行的EIB诊断方法。我们的结果显示，需要更多的试验来确定EVH检测中恰当的最小每分通气阈值，以及解释男女不同支气管痉挛刺激阈值的潜在机制。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):683-686.
The clinical utility of eucapnic voluntary hyperventilation testing for the diagnosis of exercise-induced bronchospasm.
Brummel NE, Mastronarde JG, Rittinger D, Philips G, Parsons JP.
BACKGROUND: Exercise-induced bronchospasm (EIB) is the acute, transient airway narrowing associated with exercise. Eucapnic voluntary hyperventilation (EVH) has been used to diagnose EIB in elite athletes and in research settings. The clinical utility of EVH in a general pulmonary practice has not previously been reported. Thus we sought to determine the utility and applicability of EVH testing in the clinical setting.
METHODS: We retrospectively analyzed 178 EVH tests performed at the Ohio State University Medical Center.
RESULTS: A total of 178 EVH studies were performed. Fifty patients (28%) were EIB-positive. A threshold of 60% of the predicted maximum voluntary ventilation (MVV) per minute was used as a criterion for an adequate EVH test. A majority of patients, 127 (71%), had adequate EVH tests. Females were less likely to achieve 60% MVV than males (80% vs. 55%; p = 0.002). Of the 51 patients with inadequate tests, 17 (33%) were EIB-positive; 16 of these 17 were female. Overall, EVH testing was diagnostic in 144 of 178 (81%) of patients tested.
CONCLUSIONS: We present the first description of the clinical use of EVH testing for the diagnosis of EIB in a large pulmonary practice. EVH was diagnostic in a large majority of patients. EVH is an excellent and feasible modality to diagnose EIB in patients seen in a general pulmonary practice. Our data highlight the need for further studies regarding the appropriate minimum threshold minute ventilation for an EVH test and to explain potential mechanisms for seemingly different stimulus thresholds for bronchospasm in males versus females.
Brummel NE, et al. J Asthma. 2009 Sep;46(7):683-6.
方法：我们对俄亥俄州州立大学医学中心的178次EVH检测进行回顾性研究。
结果：共进行了178次EVH检测。55例患者（28%）EIB阳性。将每分钟最大自主通气预测值（MVV）的60％作为EVH完全检测的标准。大部分患者（127名，71％）进行EVH完全检测。女性患者达到60％MVV的可能性小于男性（80% vs. 55%; p = 0.002）。对于51例未完全检测的患者，17例（33％）为阳性，其中的16例为女性患者。总体而言，EVH检测在178例患者中检测出144例阳性患者（81%）。
结论：本研究首次在临床呼吸科应用EVH诊断EIB。EVH对大部分患者具有诊断价值。在临床呼吸科，EVH是一种较好的、可行的EIB诊断方法。我们的结果显示，需要更多的试验来确定EVH检测中恰当的最小每分通气阈值，以及解释男女不同支气管痉挛刺激阈值的潜在机制。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):683-686.
The clinical utility of eucapnic voluntary hyperventilation testing for the diagnosis of exercise-induced bronchospasm.
Brummel NE, Mastronarde JG, Rittinger D, Philips G, Parsons JP.
BACKGROUND: Exercise-induced bronchospasm (EIB) is the acute, transient airway narrowing associated with exercise. Eucapnic voluntary hyperventilation (EVH) has been used to diagnose EIB in elite athletes and in research settings. The clinical utility of EVH in a general pulmonary practice has not previously been reported. Thus we sought to determine the utility and applicability of EVH testing in the clinical setting.
METHODS: We retrospectively analyzed 178 EVH tests performed at the Ohio State University Medical Center.
RESULTS: A total of 178 EVH studies were performed. Fifty patients (28%) were EIB-positive. A threshold of 60% of the predicted maximum voluntary ventilation (MVV) per minute was used as a criterion for an adequate EVH test. A majority of patients, 127 (71%), had adequate EVH tests. Females were less likely to achieve 60% MVV than males (80% vs. 55%; p = 0.002). Of the 51 patients with inadequate tests, 17 (33%) were EIB-positive; 16 of these 17 were female. Overall, EVH testing was diagnostic in 144 of 178 (81%) of patients tested.
CONCLUSIONS: We present the first description of the clinical use of EVH testing for the diagnosis of EIB in a large pulmonary practice. EVH was diagnostic in a large majority of patients. EVH is an excellent and feasible modality to diagnose EIB in patients seen in a general pulmonary practice. Our data highlight the need for further studies regarding the appropriate minimum threshold minute ventilation for an EVH test and to explain potential mechanisms for seemingly different stimulus thresholds for bronchospasm in males versus females.
Brummel NE, et al. J Asthma. 2009 Sep;46(7):683-6.
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