Astograph法乙酰甲胆碱支气管激发试验对开滦煤矿矿区人群咳嗽变异性哮喘的诊断价值  

Diagnostic value of bronchial provocation test with methacholine using Astograph method for cough variant asthma in population from Kailuan coal mining area

作　　者：杨晓燕[1] 耿贺梅[2] 刘运秋[1] 郑丽颖[1] 王丽晔[1] 宋路[1] 陈振燕 兰璇[1] YANG Xiao-yan;GENG He-mei;LIU Yun-qiu;ZHENG Li-ying;WANG Li-ye;SONG Lu;CHEN Zhen-yan;LAN Xuan(Department of Respiratory and Critical Care Medicine,Kailuan General Hospital,Tangshan 063000,China;Department of Infection Management,Kailuan General Hospital,Tangshan 063000,China;Department of Medical Education,Kailuan Mental Health Center,Tangshan 063000,China)

机构地区：[1]河北省开滦总医院呼吸与危重症医学科,唐山市063000 [2]河北省开滦总医院感染管理科,唐山市063000 [3]河北省开滦精神卫生中心医教科,唐山市063000

出　　处：《广西医学》2021年第24期2901-2906,共6页Guangxi Medical Journal

基　　金：河北省卫计委医学科学研究课题计划(ZD20140035,20171446)。

摘　　要：目的评价Astograph法乙酰甲胆碱支气管激发试验诊断开滦煤矿矿区人群咳嗽变异性哮喘(CVA)的价值。方法回顾性分析127例开滦煤矿矿区CVA患者(CVA组)和105例正常人(对照组)的资料。比较两组肺功能指标[用力肺活量(FVC)、1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC、1秒用力呼气容积占预计值的百分比、呼气流量峰值、最大呼气中段流量、25%肺活量时的用力呼气流速、50%肺活量时的用力呼气流速、75%肺活量时的用力呼气流速]及气道反应性[基础呼吸阻力(Rrs cont)、基础呼吸传导率(Grs cont)、最小诱发累积剂量(Dmin)、最小诱发累积浓度(Cmin)、传导率下降斜率(SGrs)、SGrs/Grs cont、使呼吸阻力升高到基础水平35%所需乙酰甲胆碱的累积剂量(PD_(35))]的差异,分析Astograph法乙酰甲胆碱支气管激发试验诊断CVA的敏感度、特异度、阳性预测值、阴性预测值、约登指数。结果CVA组各项肺功能指标均在正常范围内,但均低于对照组(均P<0.05)。CVA组的Rrs cont高于对照组,而Grs cont、Dmin、Cmin,PD_(35)均低于对照组(均P<0.05);CVA组的SGrs、SGrs/Grs cont水平均高于对照组,但差异均无统计学意义(均P>0.05)。Astograph法乙酰甲胆碱支气管激发试验诊断开滦煤矿矿区人群CVA的敏感度为80.3%,特异度为70.5%,阳性预测值为76.7%,阴性预测值为74.7%,约登指数为50.8%、Kappa值为0.759。Dmin诊断CVA的受试者工作特征(ROC)曲线下面积为0.903,临界值取3.703 U时,敏感度为94.8%,特异度为80.2%,约登指数为75.1%;PD_(35)诊断CVA的ROC曲线下面积为0.891,临界值取9.830 U时,敏感度为89.7%,特异度为84.6%,约登指数为74.3%。结论Astograph法乙酰甲胆碱支气管激发试验诊断开滦煤矿矿区CVA具有较高的敏感度、特异度及Kappa值,其中以Dmin≤3.703 U或PD_(35)≤9.830 U为阳性标准诊断CVA具有较高的临床应用价值。Objective To evaluate the diagnostic value of bronchial provocation test with methacholine using Astograph method for cough variant asthma(CVA)in population from Kailuan coal mining area.Methods The data of 127 CVA patients from Kailuan coal mining area(CVA group)and 105 normal individuals(control group)were retrospectively analyzed.The multiple indices were compared between the two groups,including the indices of pulmonary function(forced vital capacity[FVC],forced expiratory volume in one second[FEV_(1)],FEV_(1)/FVC,the percentage of forced expiratory volume in one second to predicted value,peak expiratory flow,maximum mid-expiratory flow,forced expiratory flow at 25%of vital capacity,forced expiratory flow at 50%of vital capacity,forced expiratory flow at 75%of vital capacity)and airway responsiveness(resistance of respiratory system at control[Rrs cont],conductance of respiratory system at control[Grs cont],minimum cumulative dose for induction[Dmin],minimum cumulative concentration for induction[Cmin],declining slope of conductance[SGrs],SGrs/Grs cont,cumulative dose of methacholine causing a 35%increase in respiratory resistance[PD_(35)]).The sensitivity,specificity,positive predictive value,negative predictive value,and Youden index of bronchial provocation test with methacholine using Astograph method for diagnosing CVA were analyzed.Results All pulmonary function indices in the CVA group were in the normal range,but were lower than those in the control group(all P<0.05).The CVA group exhibited a higher Rrs cont and lower Grs cont,Dmin,Cmin,and PD_(35) as compared with the control group(all P<0.05);the levels of SGrs and SGrs/Grs cont were higher in the CVA group than in the control group,but showing no statistically significant differences between the two groups(all P>0.05).Bronchial provocation test with methacholine using Astograph method yielded a sensitivity of 80.3%,a specificity of 70.5%,a positive predictive value of 76.7%,a negative predictive value of 74.7%,a Youden index of 50.8%and a Kappa val

关 键 词：Astograph法乙酰甲胆碱支气管激发试验 咳嗽变异性哮喘 诊断 

分 类 号：R562.25[医药卫生—呼吸系统]