哮喘控制测试前三项在判断支气管哮喘控制水平的价值  

Value of the first 3 items of asthma control test for assessing the level of bronchial asthma control

作　　者：梁振宇[1] 赵海金[1] 吕燕华[1] 董航明[1] 刘来昱[1] 朱顺芳[1] 蔡绍曦[1] 

机构地区：[1]南方医科大学南方医院呼吸科,广州510515

出　　处：《中华哮喘杂志（电子版）》2012年第2期11-14,共4页Chinese Journal of Asthma(Electronic Version)

基　　金：中华医学会慢性呼吸道疾病专项基金(08020460124);国家自然科学基金(30971328);高等学校博士学科点专项科研基金(20094433110011)

摘　　要：目的评价哮喘控制测试(ACT)前三项(ACT-3)与ACT在判断支气管哮喘(简称哮喘)控制水平时的一致性,以获得更为简便的哮喘控制评估方法。方法研究对象为南方医院门诊诊断为哮喘的患者102例,患者正在接受或未接受规范化哮喘治疗。所有患者完成ACT评分及肺功能检查。ACT评分≤19分定义为哮喘未控制,ACT评分≥20分定义为良好控制。分析ACT与ACT-3两者的相关性及与肺功能各指标的相关性,分析ACT与ACT-3判断哮喘未控制的价值,并通过kappa系数评价ACT-3与ACT判断的吻合度。结果入选的患者ACT-3与ACT的相关系数为0.919(P=0.000)。ACT-3、ACT分别于肺功能指标第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%pred)等肺功能指标呈正相关,相关系数差异均有统计学意义。ACT-3判断哮喘未控制的ROC曲线下面积(AUC)为0.974(P=0.000)。当ACT-3≤11分时,为最佳截断点,判断哮喘未控制的敏感性为94.52%,特异性为93.10%。ACT-3≤11分和ACT≤19分判断哮喘未控制的一致性检验:kappa系数=0.858(P=0.000)。结论 ACT-3能用于评价哮喘患者控制水平,以ACT-3≤11识别哮喘未控制时与ACT≤19有极高的一致性。当ACT无法完整获取时可以考虑使用ACT-3。Objective To investigate the value of the first 3 items of asthma control test（ACT-3） for evaluating level of asthma control.Methods ACT were administered to 102 asthma patients from Nanfang Hospital.Spirometry was also used.Uncontrolled asthma was defined as ACT≤19,and well controlled asthma was defined as ACT≥20.The correlation analysis between ACT,ACT-3 and the lung funcion indexes were conducted,respectively.The property of ACT-3 for identifying the uncontrolled asthma was evaluated using receiver operator characteristic（ROC） curve.And then,the agreement between ACT-3 and ACT for identifying the uncontrolled asthma was determined using kappa coefficient.Results The coefficient of correlation between the ACT-3 and ACT was 0.919（P=0.000）.Statistically significant positive correlation were observed between the ACT-3,ACT and lung funcion indexes such as forced expiratory volume in one second（FEV1）,percent predicted of FEV1,respectively.The areas under the ROC curve of ACT-3 for identifying the uncontrolled asthma was 0.974（P=0.000）.The optimal cutoff level of ACT-3 to discriminate between uncontrolled and well controlled asthma was 11 scores,giving 94.52% sensitivity and 93.10% specificity,respectively.Kappa coefficient showed a strong agreement between ACT-3 and ACT（kappa=0.858,P=0.000）.Conclusions The ACT-3 is able to assess the level of asthma control,and there＇s a strong agreement between ACT-3≤11 and ACT≤19 for identifying the uncontrolled asthma.ACT-3 may be a good choice when the full ACT is not available.

关 键 词：哮喘 哮喘控制测试 一致性 

分 类 号：R562.25[医药卫生—呼吸系统]