论文部分内容阅读
目的:寻找激发试验中预测支气管哮喘的敏感指标,建立非典型哮喘诊断方程,提高诊断的准确性。方法:疑诊支气管哮喘患者行组胺支气管激发试验,并随访3～12个月,根据随访结果分为哮喘组112例,非哮喘组63例,比较激发试验前、后2组肺通气功能等指标。结果:(1)激发试验前、后哮喘组第1秒用力呼气容积(forced expiratory volume i non esecond,FEV1)占预计值百分比(FEV1%),FEV1与用力呼气量(forced vital capacity,FVC)比(FEV1/FVC),25%～75%肺活量最大呼气流量(maximal mediate expiratory flow,MMEF)和MMEF/FVC均低于非哮喘组(P<0.05或P<0.01)。(2)哮喘组剂量反应曲线斜率(dose-response slope,DRS)大于非哮喘组(P<0.05)。(3)哮喘组和非哮喘组激发试验阳性者分别为77例和25例(χ2=14.012,P=0.000),哮喘组偏向极高敏反应是非哮喘组的6.32倍(χ2=16.291,P=0.000)。(4)Binary Logistic回归进入哮喘方程的协变量是MMEF、LogDRS和气道反应敏感度。(5)方程诊断哮喘的敏感性和特异性分别为0.829和0.762,一致性80.57%,大于MMEF、气道反应敏感度和DRS3种单一方法的任何1种(P<0.05)。结论:激发试验中反应敏感度、MMEF和DRS可作为预测哮喘的独立指标,三者综合分析可提高非典型哮喘诊断的准确性。
OBJECTIVE: To find the sensitive indexes for predicting bronchial asthma in the provocation test and establish the diagnostic equation of atypical asthma to improve the diagnostic accuracy. Methods: Patients with suspected bronchial asthma were given histamine bronchial provocation test and were followed up for 3 ~ 12 months. According to the follow-up results, they were divided into asthma group (112 cases) and non-asthma group (63 cases) index. Results: (1) FEV1%, FEV1 and forced vital capacity (FVC) of forced expiratory volume of nonsecondary blood (FEV1) in asthma group before and after stimulation test (FEV1 / FVC), maximal mediate expiratory flow (MMEF) and MMEF / FVC in 25% -75% of the patients were lower than those in the non-asthmatic group (P <0.05 or P <0.01). (2) The dose-response slope (DRS) of asthma group was higher than that of non-asthma group (P <0.05). (3) The asthmatic group and non-asthmatic group were 77 and 25 respectively (χ2 = 14.012, P = 0.000). The hyperpolarization-prone hypersensitivity in asthmatic group was 6.32 times more than that in non-asthmatic group (χ2 = 16.291, P = ). (4) Binary Logistic Regression The covariables into the asthma equation are MMEF, LogDRS and airway responsiveness. (5) The sensitivities and specificities of the equation for the diagnosis of asthma were 0.829 and 0.762, respectively, with a consistency of 80.57% and greater than that of MMEF, airway responsiveness and single DRS3 method (P <0.05). CONCLUSIONS: Response sensitivity in the challenge test, MMEF and DRS can be used as independent predictors of asthma. Comprehensive analysis of the three can improve the diagnostic accuracy of atypical asthma.