乙酰甲胆碱激发试验阴性患者对支气管扩张剂的反应能预测将来哮喘诊断
2009/12/15
背景：目前，尚缺少可靠的方法来预测乙酰甲胆碱试验（MCT）阴性患者将来被诊断为哮喘的可能性。本文主要研究MCT后给予支气管扩张剂（BD）的反应程度在预测将来哮喘诊断中的价值。
方法：从2004年1月开始，在为期5年的研究期内，对MCT检测阴性但有哮喘症状（喘息、呼吸困难）的患者，检测吸入支气管扩张剂（沙丁胺醇）后的第一秒用力呼气量（FEV1）。于2009年1月对支气管扩张剂产生明显反应（定义为FEV1增加超过200 ml和12％）的患者检查其哮喘症状。
结果：共计645名患者进行MCT检测，平均年龄21.4±2.3岁。MCT阴性（定义为PC(20) > 16 mg/mL）患者482例（74.7%），其中对支气管扩张剂产生明显反应的为35例。观察时间的中位数为2.1年，期间有11例患者（占研究人群的31.4％，占总人群的1.7％）随后被诊断为哮喘。FEV1改善超过20％对于预测哮喘的敏感性、特异性和阳性预测价值分别为86.9%, 66.6%, 83.3%（P = 0.0022）。
结论：我们的结果显示，MCT检测阴性患者给予支气管扩张剂能增加激发试验检测的诊断准确率，因为它有效鉴别将来可能被诊断为哮喘的患者。
（苏楠 审校）
J Asthma. 2009 Sep;46(7):722-725.
Bronchodilator response after negative methacholine challenge test predicts future diagnosis of asthma.
Fruchter O, Yigla M.
BACKGROUND: Currently there are no reliable means to predict the likelihood of a subject with negative results from a methacholine challenge test (MCT) to be diagnosed with asthma in the future. We sought to determine whether the magnitude of the response to bronchodilator (BD) administered after a negative MCT has a predictive value for future asthma.
METHODS: Over a 5 -year period, starting from January 2004, the change in the forced expiratory volume in 1 second (FEV(1)) after inhaling BD (salbutamol) was recorded among subjects with negative MCT despite symptoms suggestive of asthma such as wheezing and dyspnea. Subjects with a significant response to BD (defined as improvement in FEV(1) of more than 200 ml and 12%) were questioned for the presence of asthma on January 2009.
RESULTS: Overall 645 subjects (mean age 21.4 +/- 2.3 years) underwent MCT. Negative MCT (defined as PC(20) > 16 mg/mL) was noted in 482 (74.7%) patients of whom significant response to BD was identified in 35. Over a median observation time of 2.1 years, 11 of them (31.4% of the study population and 1.7% of the entire cohort) were subsequently diagnosed with asthma. Improvement of FEV(1) by 20% predicted asthma with sensitivity, specificity, and positive predictive values of 86.9%, 66.6%, 83.3%, respectively, p = 0.0022.
CONCLUSIONS: Our findings suggest that administration of BD after a negative MCT enhances the diagnostic accuracy of the challenge test as it identifies subjects who are likely to develop clinical asthma in the
J Asthma. 2009 Sep;46(7):722-5.
方法：从2004年1月开始，在为期5年的研究期内，对MCT检测阴性但有哮喘症状（喘息、呼吸困难）的患者，检测吸入支气管扩张剂（沙丁胺醇）后的第一秒用力呼气量（FEV1）。于2009年1月对支气管扩张剂产生明显反应（定义为FEV1增加超过200 ml和12％）的患者检查其哮喘症状。
结果：共计645名患者进行MCT检测，平均年龄21.4±2.3岁。MCT阴性（定义为PC(20) > 16 mg/mL）患者482例（74.7%），其中对支气管扩张剂产生明显反应的为35例。观察时间的中位数为2.1年，期间有11例患者（占研究人群的31.4％，占总人群的1.7％）随后被诊断为哮喘。FEV1改善超过20％对于预测哮喘的敏感性、特异性和阳性预测价值分别为86.9%, 66.6%, 83.3%（P = 0.0022）。
结论：我们的结果显示，MCT检测阴性患者给予支气管扩张剂能增加激发试验检测的诊断准确率，因为它有效鉴别将来可能被诊断为哮喘的患者。
（苏楠 审校）
J Asthma. 2009 Sep;46(7):722-725.
Bronchodilator response after negative methacholine challenge test predicts future diagnosis of asthma.
Fruchter O, Yigla M.
BACKGROUND: Currently there are no reliable means to predict the likelihood of a subject with negative results from a methacholine challenge test (MCT) to be diagnosed with asthma in the future. We sought to determine whether the magnitude of the response to bronchodilator (BD) administered after a negative MCT has a predictive value for future asthma.
METHODS: Over a 5 -year period, starting from January 2004, the change in the forced expiratory volume in 1 second (FEV(1)) after inhaling BD (salbutamol) was recorded among subjects with negative MCT despite symptoms suggestive of asthma such as wheezing and dyspnea. Subjects with a significant response to BD (defined as improvement in FEV(1) of more than 200 ml and 12%) were questioned for the presence of asthma on January 2009.
RESULTS: Overall 645 subjects (mean age 21.4 +/- 2.3 years) underwent MCT. Negative MCT (defined as PC(20) > 16 mg/mL) was noted in 482 (74.7%) patients of whom significant response to BD was identified in 35. Over a median observation time of 2.1 years, 11 of them (31.4% of the study population and 1.7% of the entire cohort) were subsequently diagnosed with asthma. Improvement of FEV(1) by 20% predicted asthma with sensitivity, specificity, and positive predictive values of 86.9%, 66.6%, 83.3%, respectively, p = 0.0022.
CONCLUSIONS: Our findings suggest that administration of BD after a negative MCT enhances the diagnostic accuracy of the challenge test as it identifies subjects who are likely to develop clinical asthma in the
J Asthma. 2009 Sep;46(7):722-5.
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哮喘控制和支气管高反应性及气道炎症的关系：日常实践的横断面研究
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在哮喘患儿母亲中评估家庭功能和焦虑-抑郁参数
