甘露醇干粉激发试验和运动试验在哮喘儿童哮喘诱导中作用的比较
2011/06/17
摘要
原理：甘露醇干粉(MDP)激发属于间接的支气管激发试验，该试验在成人中研究较多，但未在儿童中进行相关研究。
目的：本试验旨在评价临床上MDP激发试验和运动试验在诱导儿童哮喘中的可行性、有效性和临床意义。
方法：可能因哮喘而在两个呼吸科门诊就诊的6～16岁儿童入选本研究，采用标准化运动测试后，在随后1周内进行MDP(Aridol™, Pharmaxis, Australia)激发试验。采用Cohen’s kappa和受试者工作特征（ROC）曲线对两种试验的一致性进行比较。
结果：111名儿童接受了两种测试。12名儿童因为体力透支或不合作而未入选（11名在运动测试中排除，1名在MDP激发试验中排除），剩余的99名儿童（平均年龄11.5 ± 2.7岁）的数据进行进一步分析。受试者均能很好接受MDP测试，副作用较小，而且检测时间比运动试验要短。29名(29%)儿童MDP激发试验阳性，21名(21%)儿童运动试验阳性。83名儿童中两项检测结果一致(84%)，表明中度一致性 (κ=0.58, 95% CI 0.39-0.76)。MDP激发试验相对于运动诱发的支气管收缩，阳性和阴性预测值分别为68%和89%。对于运动测试阳性或阴性的儿童，MDP激发试验鉴别这些儿童的总体能力较好（ROC曲线下面积为0.83）。
结论：MDP激发试验用于儿童检测是可行的，可以作为儿童支气管激发试验的一个选择。
（苏楠 审校）
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21453. [Epub ahead of print]
Mannitol dry powder challenge in comparison with exercise testing in children.
Barben J, Kuehni CE, Strippoli MP, Schiller B, Hammer J, Trachsel D; On behalf of the Swiss Paediatric Respiratory Research Group.
Division of Paediatric Pulmonology, Children’s Hospital, St. Gallen, Switzerland. juerg.barben@kispisg.ch.
Abstract
RATIONALE: Mannitol dry powder (MDP) challenge is an indirect bronchial provocation test, which is well studied in adults but not established for children.
OBJECTIVE: We compared feasibility, validity, and clinical significance of MDP challenge with exercise testing in children in a clinical setting.
METHODS: Children aged 6-16 years, referred to two respiratory outpatient clinics for possible asthma diagnosis, underwent standardized exercise testing followed within a week by an MDP challenge (Aridol™, Pharmaxis, Australia). Agreement between the two challenge tests using Cohen’s kappa and receiving operating characteristic (ROC) curves was compared.
RESULTS: One hundred eleven children performed both challenge tests. Twelve children were excluded due to exhaustion or insufficient cooperation (11 at the exercise test, 1 at the MDP challenge), leaving 99 children (mean ± SD age 11.5 ± 2.7 years) for analysis. MDP tests were well accepted, with minor side effects and a shorter duration than exercise tests. The MDP challenge was positive in 29 children (29%), the exercise test in 21 (21%). Both tests were concordant in 83 children (84%), with moderate agreement (κ = 0.58, 95% CI 0.39-0.76). Positive and negative predictive values of the MDP challenge for exercise-induced bronchoconstriction were 68% and 89%. The overall ability of MDP challenge to separate children with or without positive exercise tests was good (area under the ROC curve 0.83).
CONCLUSIONS: MDP challenge test is feasible in children and is a suitable alternative for bronchial challenge testing in childhood.
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21453. [Epub ahead of print]
原理：甘露醇干粉(MDP)激发属于间接的支气管激发试验，该试验在成人中研究较多，但未在儿童中进行相关研究。
目的：本试验旨在评价临床上MDP激发试验和运动试验在诱导儿童哮喘中的可行性、有效性和临床意义。
方法：可能因哮喘而在两个呼吸科门诊就诊的6～16岁儿童入选本研究，采用标准化运动测试后，在随后1周内进行MDP(Aridol™, Pharmaxis, Australia)激发试验。采用Cohen’s kappa和受试者工作特征（ROC）曲线对两种试验的一致性进行比较。
结果：111名儿童接受了两种测试。12名儿童因为体力透支或不合作而未入选（11名在运动测试中排除，1名在MDP激发试验中排除），剩余的99名儿童（平均年龄11.5 ± 2.7岁）的数据进行进一步分析。受试者均能很好接受MDP测试，副作用较小，而且检测时间比运动试验要短。29名(29%)儿童MDP激发试验阳性，21名(21%)儿童运动试验阳性。83名儿童中两项检测结果一致(84%)，表明中度一致性 (κ=0.58, 95% CI 0.39-0.76)。MDP激发试验相对于运动诱发的支气管收缩，阳性和阴性预测值分别为68%和89%。对于运动测试阳性或阴性的儿童，MDP激发试验鉴别这些儿童的总体能力较好（ROC曲线下面积为0.83）。
结论：MDP激发试验用于儿童检测是可行的，可以作为儿童支气管激发试验的一个选择。
（苏楠 审校）
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21453. [Epub ahead of print]
Mannitol dry powder challenge in comparison with exercise testing in children.
Barben J, Kuehni CE, Strippoli MP, Schiller B, Hammer J, Trachsel D; On behalf of the Swiss Paediatric Respiratory Research Group.
Division of Paediatric Pulmonology, Children’s Hospital, St. Gallen, Switzerland. juerg.barben@kispisg.ch.
Abstract
RATIONALE: Mannitol dry powder (MDP) challenge is an indirect bronchial provocation test, which is well studied in adults but not established for children.
OBJECTIVE: We compared feasibility, validity, and clinical significance of MDP challenge with exercise testing in children in a clinical setting.
METHODS: Children aged 6-16 years, referred to two respiratory outpatient clinics for possible asthma diagnosis, underwent standardized exercise testing followed within a week by an MDP challenge (Aridol™, Pharmaxis, Australia). Agreement between the two challenge tests using Cohen’s kappa and receiving operating characteristic (ROC) curves was compared.
RESULTS: One hundred eleven children performed both challenge tests. Twelve children were excluded due to exhaustion or insufficient cooperation (11 at the exercise test, 1 at the MDP challenge), leaving 99 children (mean ± SD age 11.5 ± 2.7 years) for analysis. MDP tests were well accepted, with minor side effects and a shorter duration than exercise tests. The MDP challenge was positive in 29 children (29%), the exercise test in 21 (21%). Both tests were concordant in 83 children (84%), with moderate agreement (κ = 0.58, 95% CI 0.39-0.76). Positive and negative predictive values of the MDP challenge for exercise-induced bronchoconstriction were 68% and 89%. The overall ability of MDP challenge to separate children with or without positive exercise tests was good (area under the ROC curve 0.83).
CONCLUSIONS: MDP challenge test is feasible in children and is a suitable alternative for bronchial challenge testing in childhood.
Pediatr Pulmonol. 2011 Apr 4. doi: 10.1002/ppul.21453. [Epub ahead of print]
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