Astograph法气道反应性测定对胸闷变异性哮喘诊断价值的研究  

Diagnostic Value of Astograph Airway Responsiveness Measurement in Chest Suffocation Variant Asthma

作　　者：刘运秋 耿贺梅 郑丽颖 曹天宇 刘伟存 陈振燕 王丽晔 修春霞 宋路 陈宝丽[5] 兰璇 Liu Yunqiu;Geng Hemei;Zheng Liying;Cao Tianyu;Liu Weicun;Chen Zhenyan;Wang Liye;Xiu Chunxia;Song Lu;Chen Baoli;Lan xuan(Department of Respiratory,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Department of Infection Management,Kailuan General Hospital Affiliated to North China University of Science and Technology,Tangshan 063000,China;Department of Health,72nd Division of Hebei Army Reserve Artillery,Tangshan 063000,China;Medical Department of Kailuan Mental Health Center Affiliated to North China University of Science and Technology,Tangshan 063000,China;Department of Obstetrics and Gynecology,Tangshan Maternal and Child Health Hospital of Hebei Province,Tangshan 063000,China)

机构地区：[1]华北理工大学附属开滦总医院呼吸内科,河北省唐山市063000 [2]华北理工大学附属开滦总医院感染管理科,河北省唐山市063000 [3]河北陆军预备役炮兵第七十二师卫生科,河北省唐山市063000 [4]华北理工大学附属开滦精神卫生中心医务科,河北省唐山市063000 [5]河北省唐山市妇幼保健院妇产科063000

出　　处：《中国综合临床》2019年第4期342-346,共5页Clinical Medicine of China

摘　　要：目的探讨Astograph法乙酰甲胆碱气道反应性测定对胸闷变异性哮喘的诊断价值。方法将2011年1月至2017年2月华北理工大学附属开滦总医院呼吸内科门诊或住院的胸闷变异性哮喘患者156例作为病例组(胸闷变异性哮喘组),将同期确诊间质性肺疾病(23例)、冠心病(157例)、高血压性心脏病(22例)、心肌病(16例)、先天性心脏病(3例)、风湿性心脏瓣膜病(6例)、中心气道病变(3例)、甲状腺肿大(10例)、纵隔肿瘤(5例)、胸廓或脊柱畸形(8例)、膈肌麻痹症(2例)及自主神经功能紊乱(106例)的非哮喘患者361例做为对照组。所有受试者均行肺通气功能检查、呼吸流量峰值(peak expiratory flow,PEF)平均每日昼夜变异率或PEF周变异率、Astograph法乙酰甲胆碱气道反应性测定[基础第一秒用力呼气容积(Forced expiratory volume in one second,FEV1)≥70%预计值时]检查及引起胸闷的各种疾病的相关检查。通过分析Astograph法乙酰甲胆碱气道反应性测定诊断胸闷变异型哮喘的敏感度、特异度、阳性预测值、阴性预测值、诊断准确性及Yunden指数,探讨Astograph法乙酰甲胆碱气道反应性测定对胸闷变异型哮喘的诊断价值。结果胸闷变异性哮喘组与对照组比较用力呼气75%肺活量时气道流速差异有统计学意义[1.18±0.44)%与(1.29±0.50)%;t=2.96,P=0.006]。Astograph法乙酰甲胆碱气道反应性测定诊断胸闷变异型哮喘的敏感度、特异度、阳性预测值、阴性预测值、Yunden指数及诊断准确性分别为0.81、0.69、0.53、0.30、0.50及0.73。结论Astograph法乙酰甲胆碱气道反应性测定诊断胸闷变异性哮喘的敏感度、阴性预测值、Youden指数和诊断准确性均较高,特异度和阳性预测值偏低,提示Astograph法乙酰甲胆碱气道反应性测定对胸闷变异性哮喘有较高的诊断价值,假阴性偏低,假阳性略高。Objective To investigate the diagnostic value of Astograph methacholine provocation test in patients with chest tightness variant asthma(CTVA).Methods From January 2011 to February 2017,156 patients with CTVA in outpatient or inpatient department of respiratory medicine of Kailuan General Hospital affiliated to North China University of Science and Technology were selected as case group(chest tightness variant asthma group).The control group were 361 non-asthmatic patients including interstitial lung disease(23 cases),coronary disease(157 cases),hypertensive cardiopathy(22 cases),myocardiosis(16 cases),congenital heart disease(3 cases),rheumatic valvular heart disease(6 cases),central airway disease(3 cases),thyromegaly(10 cases),mediastinal tumor(5 cases),thoracic or spinal deformity(8 cases),phrenoparalysis(2 cases)and vegetative nerve functional disturbance(106 cases).All participants received pulmonay ventilation test,average daily and nightly variation rate of PEF(Peak expiratory flow)or PEF weekly variability,Astograph methacholine provocation test(forced expirataory volume in one second≥70%expectation),and other relevant examinations.The diagnostic value of Astograph methacholine provocation test on CTVA was assessed by analyzing the sensitivity,specificity,positive predictive value,negative predictive value,and Yunden index of Astograph methacholine airway.Results Compared with the control group((1.18±0.44)%),theforced expiratory flow from 75%of Forced vital capcacity(FEF75)index of CTVA group((1.29±0.50)%)had significant difference(,t=2.96,P=0.006).The sensitivity,specificity,positive predictive value,negative predictive value,Yunden index,and diagnostic accuracy of Astograph methacholine provocation test on CTVA were 0.814,0.695,0.536,0.305,0.509 and 0.731,respectively.Conclusion The sensitivity,negative predictive value,Yunden index and diagnostic accuracy of Astograph methacholine provocation test on CTVA were higher,whereas the specificity and positive predictive value were relatively lower,sugge

关 键 词：气道反应性测定 胸闷变异性哮喘 诊断 

分 类 号：R562.25[医药卫生—呼吸系统]