定点连续测量PEF的差异对职业性哮喘的诊断意义
2010/08/20
职业性哮喘的诊断要求客观证据。在诊断中连续检测PEF是最简便易行的首要步骤。此外有一种新的方法，此方法最初用来对晚期哮喘患者对特殊吸入试验的反应。这种方法作为现有的检验PEF方法的补充手段，应用于在工作场合连续多日的PEF测定。
Burge等人从工人中选取236名诊断为职业性哮喘的患者，320名没有诊断哮喘的员工作为对照。休息日的测量结果的合并标准差通过固定时间点的方差分析获得。工作日的PEF测量结果以2小时为单位测量取平均值获得。定点测量工作日的平均PEF低于休息日的PEF水平（测量次数差异调整后）。
通过最少4个时间点的测量进行比较。结果显示≥2个时间点的工作日测量结果显著降低对职业性哮喘的诊断，其敏感度为67%，特异度为99%。降低条件至≥1个非清醒时段的结果差异则敏感度升为77%，特异度降至93%。该研究的有效记录仅达43%，分析主要原因是由于工作日和非工作日清醒时间段有所差别。
Burge等人的研究指出固定时间点分析可以做为诊断职业性哮喘的测量PEF方法的一种辅助手段。与其他研究方法相比，固定时间点测量需要的记录更短，不需要办公自动化评分，且能发现更微小的变化，但是取决于较少的休息日PEF结果的变异。
(于娜 沈阳中国医科大学附属第一医院呼吸内科 110001 摘译)
（Thorax 2009;64:1032-1036 /doi:10.1136/thx.2009.120923）
（Thorax 2009;64:1032-1036 /doi:10.1136/thx.2009.120923）
Diagnosis of occupational asthma from time point differences in serial PEF measurements
1. C B S G Burge,
2. V C Moore,
3. C F A Pantin,
4. A S Robertson,
5. P S Burge
Abstract
Background: The diagnosis of occupational asthma requires objective confirmation. Analysis of serial measurements of peak expiratory flow (PEF) is usually the most convenient first step in the diagnostic process. A new method of analysis originally developed to detect late asthmatic reactions following specific inhalation testing is described. This was applied to serial PEF measurements made over many days in the workplace to supplement existing methods of PEF analysis.
Methods: 236 records from workers with independently diagnosed occupational asthma and 320 records from controls with asthma were available. The pooled standard deviation for rest day measurements was obtained from an analysis of variance by time. Work day PEF measurements were meaned into matching 2-hourly time segments. Time points with mean work day PEF statistically lower (at the Bonferroni adjusted 5% level) than the rest days were counted after adjusting for the number of contributing measurements.
Results: A minimum of four time point comparisons were needed. Records with ≥2 time points significantly lower on work days had a sensitivity of 67% and a specificity of 99% for the diagnosis of occupational asthma against independent diagnoses. Reducing the requirements to ≥1 non-waking time point difference increased sensitivity to 77% and reduced specificity to 93%. The analysis was only applicable to 43% of available records, mainly due to differences in waking times on work and rest days.
Conclusion: Time point analysis complements other validated methods of PEF analysis for the diagnosis of occupational asthma. It requires shorter records than are required for the Oasys score and can identify smaller changes than other methods, but is dependent on low rest day PEF variance.
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