联合使用哮喘控制测试（ACT）和肺功能检测预测未来哮喘恶化
2009/11/16
背景：已经报道诸多因素能用于预测未来哮喘恶化。
目的：本试验旨在研究联合运用基于患者的问卷调查[如哮喘控制测试（ACT）评分]和客观评价[如第1秒用力呼气量FEV1和/或呼出气一氧化氮(FE(NO))在成人哮喘患者中预测未来哮喘恶化的作用。
方法：共纳入78名临床稳定期达3个月，并接受常规糖皮质激素吸入治疗的轻-中度哮喘患者。对所有患者进行常规哮喘控制评估，包括ACT评分、肺活量检测和FE(NO)，然后对其进行随访，直至出现哮喘严重恶化。采用基于分类和回归树分析的决策树确定和验证哮喘严重恶化风险增加的预测因子。通过受试者工作特征曲线下面积（AUC）（95%可信区间，CI）来评价所建立模型的可信度。
结果：CART分析自动选择参数和截值点，ACT评分≤23和FEV1≤91.8% 能最大程度辨别未来1年内的哮喘恶化。若可能性采用阳性检测似然比（LP）计算，以LP为1.82计算，ACT评分≤23预测将来哮喘的可能性为60.3%。若联合使用ACT评分≤23和FEV1预测值≤91.8%，以LP为5.43计算，其预测将来哮喘的可能性为85.0%。
结论：上述结果显示，联合应用ACT评分和FEV1预测值百分数，而不是FE(NO)，能对未来1年内的哮喘恶化风险进行有效分层。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):677-682.
The strategy for predicting future exacerbation of asthma using a combination of the Asthma Control Test and lung function test.
Sato R, Tomita K, Sano H, Ichihashi H, Yamagata S, Sano A, Yamagata T, Miyara T, Iwanaga T, Muraki M, Tohda Y.
BACKGROUND: Various factors have been reported to be useful for predicting future exacerbations.
OBJECTIVE: This study was intended to determine a usefulness of a combination of a patient-based questionnaire, such as the Asthma Control Test (ACT) score with objective assessments, such as forced expiratory volume in 1 second (FEV(1)) and/or exhaled nitric oxide (FE(NO)), for predicting future exacerbations in adult asthmatics.
METHODS: We therefore enrolled 78 subjects with mild to moderate asthma, who were clinically stable for 3 months who all had been regularly receiving inhaled steroid treatment. All subjects underwent a routine assessment of asthma control including the ACT score, spirometry, and FE(NO), and then were followed up until a severe exacerbation occurred. The predictors of an increased risk of severe exacerbation were identified and validated using decision trees based on a classification and regression tree (CART) analysis. The properties of the developed models were the evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI]).
RESULTS: The CART analysis automatically selected the variables and cut-off points, the ACT score
CONCLUSION: These results demonstrated that combining the ACT score and percentage of predicted FEV(1), but not FE(NO,) can sufficiently stratify the risk for future exacerbations within one year.
Sato R, et al. J Asthma. 2009 Sep;46(7):677-82.
目的：本试验旨在研究联合运用基于患者的问卷调查[如哮喘控制测试（ACT）评分]和客观评价[如第1秒用力呼气量FEV1和/或呼出气一氧化氮(FE(NO))在成人哮喘患者中预测未来哮喘恶化的作用。
方法：共纳入78名临床稳定期达3个月，并接受常规糖皮质激素吸入治疗的轻-中度哮喘患者。对所有患者进行常规哮喘控制评估，包括ACT评分、肺活量检测和FE(NO)，然后对其进行随访，直至出现哮喘严重恶化。采用基于分类和回归树分析的决策树确定和验证哮喘严重恶化风险增加的预测因子。通过受试者工作特征曲线下面积（AUC）（95%可信区间，CI）来评价所建立模型的可信度。
结果：CART分析自动选择参数和截值点，ACT评分≤23和FEV1≤91.8% 能最大程度辨别未来1年内的哮喘恶化。若可能性采用阳性检测似然比（LP）计算，以LP为1.82计算，ACT评分≤23预测将来哮喘的可能性为60.3%。若联合使用ACT评分≤23和FEV1预测值≤91.8%，以LP为5.43计算，其预测将来哮喘的可能性为85.0%。
结论：上述结果显示，联合应用ACT评分和FEV1预测值百分数，而不是FE(NO)，能对未来1年内的哮喘恶化风险进行有效分层。
（林江涛 审校）
J Asthma. 2009 Sep;46(7):677-682.
The strategy for predicting future exacerbation of asthma using a combination of the Asthma Control Test and lung function test.
Sato R, Tomita K, Sano H, Ichihashi H, Yamagata S, Sano A, Yamagata T, Miyara T, Iwanaga T, Muraki M, Tohda Y.
BACKGROUND: Various factors have been reported to be useful for predicting future exacerbations.
OBJECTIVE: This study was intended to determine a usefulness of a combination of a patient-based questionnaire, such as the Asthma Control Test (ACT) score with objective assessments, such as forced expiratory volume in 1 second (FEV(1)) and/or exhaled nitric oxide (FE(NO)), for predicting future exacerbations in adult asthmatics.
METHODS: We therefore enrolled 78 subjects with mild to moderate asthma, who were clinically stable for 3 months who all had been regularly receiving inhaled steroid treatment. All subjects underwent a routine assessment of asthma control including the ACT score, spirometry, and FE(NO), and then were followed up until a severe exacerbation occurred. The predictors of an increased risk of severe exacerbation were identified and validated using decision trees based on a classification and regression tree (CART) analysis. The properties of the developed models were the evaluated with the area under the ROC curve (AUC) (95% confidence interval [CI]).
RESULTS: The CART analysis automatically selected the variables and cut-off points, the ACT score
Sato R, et al. J Asthma. 2009 Sep;46(7):677-82.
上一篇：
伴支气管高反应性的成人哮喘患者中呼出气一氧化碳：一项前瞻性研究
下一篇：
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
