支气管舒张试验诊断标准的临床研究  

The standard of diagnosing on bronchodilation test

作　　者：王波[1,2] 

机构地区：[1]中国医科大学第五附属医院 [2]本钢总医院呼吸内科,辽宁本溪117000

出　　处：《中国医药导报》2010年第7期29-31,共3页China Medical Herald

摘　　要：目的:观察支气管舒张试验中吸入沙丁胺醇不同剂量测定FEV1及不同的阳性标准对支气管舒张试验结果的影响。方法:选择支气管哮喘患者50例,COPD患者50例,健康对照组50例,吸入200μg和400μg沙丁胺醇,于15min后,重复测定FEV1,计算舒张试验阳性率。结果:以FEV1改善率≥15%且FEV1增加绝对值>200ml舒张试验阳性标准判断,诊断哮喘的灵敏度为76%,特异性可达到100%;以FEV1改善率≥12%且FEV1增加绝对值>200ml舒张试验阳性标准判定其舒张试验阳性结果,灵敏度为92%,特异性可达到99%;以FEV1改善率≥10%为舒张试验阳性标准判断,诊断哮喘的灵敏度为100%,特异性可达到80%。吸入不同剂量沙丁胺醇后舒张试验阳性率比较无显著性差异(P>0.05)。COPD组和健康对照组舒张试验阳性率与吸入沙丁胺醇的剂量亦无相关性(P>0.05)。结论:支气管舒张试验中,采用200μg沙丁胺醇的剂量可以充分发挥其舒张支气管的良好效能,增加剂量对其阳性结果无统计学意义;以FEV1改善率≥12%且FEV1增加绝对值>200ml舒张试验阳性判断标准,诊断哮喘的临床价值更大,能够有效减少误诊率和漏诊率。Objective： To compare and analyze the effects of different standands of diagnosing on bronchodilation test. Methods： Three groups of subjects （50 patients with asthma, 50 patients with COPD, and 50 normal control ） were induced in this study. The forced expiratory volume in the first second （FEV1） was evaluated in the positive rates at 15 minutes after inhaling 200 μg or 400 μg salbutamol. Results： If using absolute change of FEV1〉200 ml and improving rate FEV1≥ 15% as the positive standard, the best combination of sensitivity （76%） and specificity （100%） of diagnosing asthma was achieved. If using absolute change of FEV1〉200 ml and improving rate of FEV1 ≥ 12% as the positive standard, the best combination of sensitivity （92%） and specificity （99%） of diagnosing asthma was achieved. If using improving rate FEV1≥ 10% as the positive standard, the best combination of sensitivity （100%） and specificity （80%） of diagnosing asthma was achieved. There was no significant difference between patients inhaling 200 μg salbutamol. In the patients with COPD and in normal control, the positive rate was no significant difference between patients inhaling different dose of salbutamol. Conclusion： FEV1 at 15 minutes after inhaling 200 μg salbutamol is the best choice as it is highly efficient and cause less side effects. We suggest that an absolute increase of FEV1〉200 ml and improving rate FEV1 ≥ 12% should be the positive standard of diagnosing asthma, and can effectively reduce the misdiagnosis rate and missed diagnosis rate.

关 键 词：哮喘 慢性阻塞性肺疾病 呼吸功能试验 沙丁胺醇 

分 类 号：R562.25[医药卫生—呼吸系统]