哮喘控制测试的最小显著差异值
2009/12/15
背景：哮喘控制测试（ACT）的有效性已经得到证实，但其最小显著差异值（MID）尚未有一致的结论。
目的：明确ACT的MID。
方法：数据来源于针对成人哮喘患者的4个独立试验。寻找MID的分配方法包括0.5 SD, 1 SEM和2 SEM。 采用基于链接的方法评价ACT 评分差异与下列指标的关系（1）自我主诉的哮喘严重程度；（2）过去4周的哮喘发作频率；（3）医生对哮喘控制的分级；（4）医生推荐改变治疗计划；（5）FEV1；（6）未来12个月短效β激动剂使用过量及哮喘恶化的风险；（7）患者描述的3个月内哮喘病程的变化。
结果：共计4118名患者完成ACT。MID的0.5 SD标准从2.03～2.45（平均2.2）。1 SEM标准从1.77～2.05（平均1.88）。2 SEM标准从3.55～4.10（平均3.75）。不同组平均ACT评分差异因不同检测标准而不同，差异范围从1.06～28（平均3.1）。预测分析显示，ACT 3点的差异与随后过度使用短效β激动剂风险增加76％（95% CI, 73%～79%）及哮喘恶化风险增加33％（95% CI, 31%～35%）相关。
结论：上述结果显示，ACT的MID为3。
（林江涛 审校）
J Allergy Clin Immunol. 2009 Oct;124(4):719-723.
The minimally important difference of the Asthma Control Test.
Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P.
BACKGROUND: The Asthma Control Test (ACT) has been well validated, but a minimally important difference (MID) has not been established.
OBJECTIVE: We sought to identify an MID for the ACT.
METHODS: Data come from 4 independent samples of adult asthmatic patients. Distributional methods for determining the MID included 0.5 SD, 1 SEM, and 2 SEM. Anchor-based methods assessed the relationship of differences in ACT scores to (1) self-reported asthma severity, (2) asthma episode frequency in the past 4 weeks, (3) physician ratings of asthma control, (4) physician recommendation of a change in therapy, (5) FEV(1), (6) the risk over the next 12 months of excess short-acting beta-agonist use and exacerbations, and (7) patient-defined changes in asthma course over 3 months.
RESULTS: Four thousand one hundred eighteen patients completed the ACT. The 0.5 SD criterion for MID ranged from 2.03 to 2.45 points (mean, 2.2 points). The 1 SEM criterion ranged from 1.77 to 2.05 points (mean, 1.88 points), and the 2 SEM criterion ranged from 3.55 to 4.10 points (mean, 3.75 points). Differences in mean ACT scores across patient groups differing on criterion measures ranged from 1.06 to 5.28 points (mean, 3.1 points). Predictive analyses showed that a difference of 3 points on the ACT was associated with a subsequent 76% increased risk (95% CI, 73% to 79%) of excess short-acting beta-agonist use and a 33% increased risk (95% CI, 31% to 35%) of exacerbations.
CONCLUSION: The data support an MID for the ACT of 3 points.
Schatz M, Kosinski M, Yarlas AS, et al. J Allergy ClinImmunol.2009Oct;124(4):719-23.
目的：明确ACT的MID。
方法：数据来源于针对成人哮喘患者的4个独立试验。寻找MID的分配方法包括0.5 SD, 1 SEM和2 SEM。 采用基于链接的方法评价ACT 评分差异与下列指标的关系（1）自我主诉的哮喘严重程度；（2）过去4周的哮喘发作频率；（3）医生对哮喘控制的分级；（4）医生推荐改变治疗计划；（5）FEV1；（6）未来12个月短效β激动剂使用过量及哮喘恶化的风险；（7）患者描述的3个月内哮喘病程的变化。
结果：共计4118名患者完成ACT。MID的0.5 SD标准从2.03～2.45（平均2.2）。1 SEM标准从1.77～2.05（平均1.88）。2 SEM标准从3.55～4.10（平均3.75）。不同组平均ACT评分差异因不同检测标准而不同，差异范围从1.06～28（平均3.1）。预测分析显示，ACT 3点的差异与随后过度使用短效β激动剂风险增加76％（95% CI, 73%～79%）及哮喘恶化风险增加33％（95% CI, 31%～35%）相关。
结论：上述结果显示，ACT的MID为3。
（林江涛 审校）
J Allergy Clin Immunol. 2009 Oct;124(4):719-723.
The minimally important difference of the Asthma Control Test.
Schatz M, Kosinski M, Yarlas AS, Hanlon J, Watson ME, Jhingran P.
BACKGROUND: The Asthma Control Test (ACT) has been well validated, but a minimally important difference (MID) has not been established.
OBJECTIVE: We sought to identify an MID for the ACT.
METHODS: Data come from 4 independent samples of adult asthmatic patients. Distributional methods for determining the MID included 0.5 SD, 1 SEM, and 2 SEM. Anchor-based methods assessed the relationship of differences in ACT scores to (1) self-reported asthma severity, (2) asthma episode frequency in the past 4 weeks, (3) physician ratings of asthma control, (4) physician recommendation of a change in therapy, (5) FEV(1), (6) the risk over the next 12 months of excess short-acting beta-agonist use and exacerbations, and (7) patient-defined changes in asthma course over 3 months.
RESULTS: Four thousand one hundred eighteen patients completed the ACT. The 0.5 SD criterion for MID ranged from 2.03 to 2.45 points (mean, 2.2 points). The 1 SEM criterion ranged from 1.77 to 2.05 points (mean, 1.88 points), and the 2 SEM criterion ranged from 3.55 to 4.10 points (mean, 3.75 points). Differences in mean ACT scores across patient groups differing on criterion measures ranged from 1.06 to 5.28 points (mean, 3.1 points). Predictive analyses showed that a difference of 3 points on the ACT was associated with a subsequent 76% increased risk (95% CI, 73% to 79%) of excess short-acting beta-agonist use and a 33% increased risk (95% CI, 31% to 35%) of exacerbations.
CONCLUSION: The data support an MID for the ACT of 3 points.
Schatz M, Kosinski M, Yarlas AS, et al. J Allergy ClinImmunol.2009Oct;124(4):719-23.
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在支气管哮喘中高敏感性C反应蛋白与痰液细胞计数的关系
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哮喘患者的呼出气一氧化氮水平：个人最佳值和参考值
