胸闷症状及年龄增加对咳嗽变异性哮喘患者单用吸入激素治疗效果的预测价值  

Predictive value of chest tightness and age increasing for inhaled corticosteroids alone in cough variant asthma

作　　者：包婺平[1] 张旻 殷俊锋[2] 王鑫博 宋启凡 郭璐 周新[1] 张国清[1] Bao Wuping;Zhang Min;Yin Junfeng;Wang Xinbo;Song Qifan;Guo Lu;Zhou Xin;Zhang Guoqing(Department of Respiratory Medicine,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;School of Mathematical Sciences,Tongji University,Shanghai 200091,China;School of Life Sciences and Technology,Tongji University,Shanghai 200091,China)

机构地区：[1]上海交通大学附属第一人民医院呼吸科,200080 [2]同济大学数学科学学院,上海200091 [3]同济大学生命科学与技术学院,上海200091

出　　处：《国际呼吸杂志》2020年第14期1054-1060,共7页International Journal of Respiration

基　　金：国家自然科学基金(81873402、81800020)。

摘　　要：目的对支气管扩张剂联合吸入型糖皮质激素(ICS)治疗咳嗽变异型哮喘(CVA)研究进行回顾性数据再分析,分析单用ICS治疗疗效明显和疗效不佳人群之间的临床特性差异,寻找预测治疗效果的临床因素。方法计算患者基线期与治疗8周时的咳嗽评分差,评估病情改善情况,咳嗽评分改善超过3分视为咳嗽好转,并分为咳嗽好转组和咳嗽无好转组。通过方差分析或Wilcoxon秩和检验分析组间差异。对存在组间差异的项目进行逻辑回归并绘制ROC曲线,计算曲线下面积(AUC)和最佳临界值。基于AUC选择二元逻辑回归变量,优化回归模型,并计算二分预测概率值。结果共41例受试者签署了数据再分析的知情同意书。咳嗽好转组(22例)和咳嗽无好转组(19例)之间血小板、第1秒用力呼气容积(FEV1)、用力呼气75%肺活量时的最大呼气流量(FEF75%)、是否胸闷以及年龄比较,差异均有统计学意义(P值均<0.05)。年龄、激发试验时FEV1下降绝对值、FEF75%预测咳嗽治疗效果的AUC相对较高(临界值分别为48岁、1.15 L和79.3%时,AUC分别为0.805、0.725和0.718)。年龄与胸闷症状联合应用的预测模型AUC达到0.847(95%CI:0.730~0.965)。年龄每增加10岁,治疗效果显著的机会减少大约51.8%,胸闷患者治疗有效的机会相比非胸闷患者减少约92.4%。结论CVA患者胸闷症状及年龄增加提示单用ICS治疗效果不佳,胸闷CVA患者或者年龄48岁以上的非胸闷CVA患者应当考虑ICS联合支气管扩张剂治疗。Objective To clarify the differences in clinical characteristics between patients with and without effective responses of inhaled corticostroid(ICS)alone,and to find out the predictors of clinical response of ICS without bronchodilator for cough variant asthma(CVA),based on re-analysis of data from a clinical study of ICS and procaterol conducted in CVA patient.Methods The difference in cough scores between baseline and follow-up visits was calculated.The patients with improvement on cough score more than 3 points were included in cough-improved group and others were included in unimproved group.The differences between groups were analyzed by ANOVA or Wilcoxon rank sum test.The items with between-group difference were logically regressed and the area under ROC curves(AUC)and the optimal critical value were calculated.The regression model was optimized by selecting binary logic regression variables and AUC was also calculated.Results Totally,41 subjects signed informed consent to data re-analysis.There were significant differences in platelet,forced expiratory volume in one second(FEV1),forced expiratory flow at 75%of FVC(FEF75%),chest tightness,and age between the cough-improved group(n=22)and unimproved group(n=19)(all P<0.05).The AUC of age,FEV1%pred,and FEF75%were higher than other parameters(AUC=0.805,0.725,and 0.718,and the cut-off values were 48 years,1.15 L and 79.3%,respectively).Age combined with FEV1%pred or FEV75%did not improve the predictive value,while the combination of age and chest tightness can improve AUC to 0.847(95%CI:0.730-0.965).For every 10-year increase in age,the chances of having effective response were reduced by 51.8%.That of patients with chest tightness was about 92.4%less than that of non-tightness patients.Conclusions The symptoms of chest tightness and age increasing predict useless of ICS alone in CVA patients.ICS combined with bronchodilators should be considered in CVA patients with chest tightness,or in non-tightness CVA patients over 48 years of age.

关 键 词：哮喘 咳嗽 症状 年龄 吸入糖皮质激素 

分 类 号：R562.25[医药卫生—呼吸系统]