不同剂量乙酰甲胆碱对以胸闷为主诉的不典型支气管哮喘的诊断价值  

Clinical value of different doses of methacholine in the diagnosis of atypical asthma with chest tightness

作　　者：吴媛媛[1] 孙秀珍[1] 刘昀[1] 李芳侠[1] WU Yuanyuan SUN Xiuzhen LIU Yun LI Fangxia(Department of Respiratory Medicine, Second Affiliated Hospital, Xi＇an Jiaotong University College of Medicine, Xi ＇ an 710004, China)

机构地区：[1]西安交通大学第二附属医院呼吸内科,西安710004

出　　处：《山西医科大学学报》2017年第9期949-951,共3页Journal of Shanxi Medical University

摘　　要：目的探讨不同剂量乙酰甲胆碱对以胸闷为主诉的不典型支气管哮喘的诊断意义。方法选取2014-01~2015-12在呼吸内科门诊以胸闷为主诉就诊,行支气管激发试验阳性的74位患者为研究对象。根据激发试验阳性所需乙酰甲胆碱的剂量,将研究对象分为4组:<0.25 mg组;0.25-<0.5 mg组;0.5-<1 mg组;1-<2.5 mg组。各组患者均按哮喘应用糖皮质激素吸入方案治疗:信必可(布地奈德福莫特罗粉吸入剂160μg∶4.5μg,2次/d,持续4周)。分别于治疗前和治疗后1月,通过哮喘控制测试(asthma control test,ACT)和哮喘治疗评估问卷(asthma therapy assessment questionnaire,ATAQ)对胸闷症状的控制进行评估。结果支气管激发试验阳性,且累积吸入乙酰甲胆碱量小于1 mg的3个组中,患者吸入信必可治疗后,ACT评分与治疗前相比较,明显升高(P<0.05),ATAQ评分与治疗前相比较,明显降低(P<0.05);在乙酰甲胆碱量≥1 mg的组中,ACT评分和ATAQ评分与治疗前相比较,差异无统计学意义(P>0.05)。结论在支气管激发试验阳性,但所需乙酰甲胆碱量≥1 mg的患者中,按哮喘治疗的效果差,提示患有哮喘的可能性比较小;不同剂量乙酰甲胆碱对以胸闷为主诉的不典型支气管哮喘具有一定的诊断价值。Objective To evaluate the diagnostic value of different doses of methacholine for atypical asthma with chest tightness.Methods Subjects with chest tightness were selected in the outpatient department of our hospital from January 2014 to December 2015.Seventy-four patients with positive results in bronchial provocation tests were enrolled and divided into four groups according to the doses of methacholine in the tests： 0. 25 mg group,0. 25-0. 5 mg group,0. 5-1 mg group,and 1-2. 5 mg group. All the enrolled patients were treated with symbicort（ Budesonide and Formoterol Powder,160 μg ∶4. 5 μg） twice a day for 4 weeks. The scores of symptoms were evaluated before treatment and at 1 month after symbicort turbuhaler treatment. Results After the treatment,the asthma control test（ ACT） scores were increased（ P〈0. 05）,and the asthma therapy assessment questionnaire（ ATAQ） scores were decreased in0. 25 mg group,0. 25-0. 5 mg group,and 0. 5-1 mg group（ P〈0. 05）,however,there was no statistical change in 1-2. 5 mg group（ P〈0. 05）. Conclusion Patients with positive results in bronchial provocation tests and the dose of methacholine≥1mg,have a poor effect and are less likely to suffer from asthma. Different doses of methacholine have a certain diagnostic value in treatment of atypical asthma with chest tightness.

关 键 词：乙酰甲胆碱 胸闷 不典型哮喘 诊断价值 

分 类 号：R562.25[医药卫生—呼吸系统]