慢性咳嗽疑似咳嗽变异型哮喘成人患者的支气管舒张反应试验的预测价值  

Predictive value of bronchial diastolic response test in adult patients with chronic cough suspected as cough variant asthma

作　　者：韩丽娜 李杨杨 白晓敏[1] HAN Lina;LI Yangyang;BAI Xiaomin(the First Department of Respiratory and Critical Care Medicine,Handan City First Hospital in Hebei Province,Handan,Hebei,056000)

机构地区：[1]河北省邯郸市第一医院呼吸与危重病医学一科,河北邯郸056000

出　　处：《实用临床医药杂志》2024年第9期95-98,共4页Journal of Clinical Medicine in Practice

基　　金：河北省邯郸市科学技术研究与发展计划项目(19422083010-21)。

摘　　要：目的 探讨支气管舒张反应(BDR)试验预测慢性咳嗽且BDR试验阴性患者咳嗽变异性哮喘(CVA)的价值。方法 选取140例慢性咳嗽、BDR试验阴性患者为研究对象,患者均接受4周的吸入性糖皮质激素(ICS)和长效β2-激动剂治疗,并对治疗前后的肺功能进行检测。采用受试者工作特征(ROC)曲线评估患者第1秒用力呼吸容积占预计值百分比(FEV_(1)%)、呼出气一氧化氮(FeNO)、用力呼气25%~75%肺活量的瞬间流量(FEF_(25%~75%))和用力呼气25%~75%肺活量的瞬间流量占预计值的百分比(FEF%_(25%~75%))的单独诊断及联合诊断的预测价值。结果 治疗后,CVA阴性者98例,CVA阳性者42例。在联合评估指标组合中,对CVA的诊断排名前3位的指标组合分别是FEF%_(25%~75%)+△FEV_(1)%、FEF25%~75%+FeNO和△FEV_(1)+△FEV_(1)%。联合预测的维恩图结果显示,FeNO≥41.50×10^(-9)mol/L、△FEV_(1)%≥5.90%、FEF%25%~75%≤61.99%的CVA阳性诊断患者存在重叠。结论 治疗后,患者FeNO≥41.50×10^(-9)mol/L、△FEV_(1)%≥5.90%、FEF%25%~75%≤61.99%可用于预测CVA和对哮喘治疗的反应。Objective To explore the value of bronchial diastolic response(BDR)test in predicting the cough variant asthma(CVA)in patients with chronic cough or negative result of BDR test.Methods A total of 140 patients with chronic cough and negative result of BDR test were selected and treated with inhaled corticosteroids(ICS)and long-actingβ2-agonists for 4 weeks,and their lung functions were detected before and after treatment.Receiver operating characteristic(ROC)curve was used to evaluate the predictive values of the forced expiratory volume in the first second as a percentage of predicted value(FEV_(1)%),exhaled nitric oxide(FeNO),forced expiratory flow at 25%to 75%(FEF _(25%to 75%))and forced expiratory flow rate in 25%to 75%(FEF%_(25%to 75%))alone or their combined diagnosis.Results After treatment,there were 98 cases diagnosed as negative for CVA and 42 cases diagnosed as positive for CVA.In combination of evaluation indexes,the top three combinations for CVA diagnosis were FEF%_(25%to 75%)+△FEV_(1)%,FEF 25%to 75%+FeNO,and△FEV_(1)+△FEV_(1)%.Venn diagram of the combined prediction showed that there was an overlap in CVA positive diagnostic patients with FeNO≥41.50×10^(-9) mol/L,△FEV_(1)%≥5.90%,and FEF%25%to 75%≤61.99%.Conclusion After treatment,patient′s showing FeNO≥41.50×10^(-9) mol/L,△FEV_(1)%≥5.90%and FEF%25%to 75%≤61.99%can be used to predict CVA and the response to anti-asthma treatment.

关 键 词：慢性咳嗽 咳嗽变异性哮喘 支气管舒张反应试验 肺功能 预测价值 

分 类 号：R562.2[医药卫生—呼吸系统] R441.5[医药卫生—内科学] R443[医药卫生—临床医学]