摘要
目的：比较组胺支气管激发试验（His-BPT）与乙酰甲胆碱支气管激发试验（Mch-BPT）的诊断价值及不良反应差异,为临床激发药物的选择提供参考。方法招募哮喘患者28例（哮喘组）、感染后咳嗽（cough post infection,CPI）患者23例（CPI 组）及健康志愿者21名（正常对照组）。所有受试者按照随机自身交叉对照原则分别进行 His-BPT 与 Mch-BPT,比较两种试验的灵敏度、特异度及不良反应差异。结果① His-BPT 与 Mch-BPT 的灵敏度分别为90%和83%；特异度分别为89%和100%；准确度分别为89%和93%；阳性预测价值分别为84%和100%；阴性预测价值分别为93%和90%。②His-BPT 的 ROC 曲线下面积为0.959（95% CI ：0.916-1.001）,P 〈0.01；Mch-BPT 的 ROC 曲线下面积为0.957（95% CI ：0.901-1.013）,P 〈0.01；③哮喘组不良反应以咳嗽（His-BPT：64.29%, Mch-BPT：50%, P =0.10）、咽干（His-BPT：57.14%, Mch-BPT：35.71%,P =0.17）、气紧（His-BPT：82.14%,Mch-BPT：78.57%,P =0.92）与胸闷（His-BPT：32.14%,Mch-BPT：25%,P =0.40）为主；CPI 组以咳嗽（His-BPT：66%,Mch-BPT：44%,P 〈0.01）、咽干（His-BPT：43%,Mch-BPT：57%,P =0.47）以及气紧（His-BPT：22%,Mch-BPT：19%,P =0.40）为主；正常对照组中 His-BPT 的咳嗽（67%）及声嘶发生率（29%）显著均高于Mch-BPT （咳嗽：38%,P 〈0.01；声嘶发生率：5%,P =0.05）。结论两种激发试验均对哮喘有较高的诊断价值,Mch-BPT 特异度较高但敏感度稍逊,His-BPT 不良反应比例略高,两者均无发生严重不良反应,故两者均适合在临床上推广使用。
Objective To provide a choice of drug for provocation test in clinic by comparing the diagnostic value and adverse effect between histamine bronchial provocation test （His-BPT） and methacholine bronchial provocation test（Mch-BPT）.Methods 28 patients with asthma,23 patients with cough post infection（CPI） were enrolled and 21 healthy subjects as volunteers.Accoding to a crossover-control design,all of the patients were assigned to group with His-BPT or Mch-BPT randomly.The sensitivity,specificity and adverse effect of this two provocation methods were compared.Results ① The sesitivit,specificity,accuracy,positive predictive value and negtive predictive value of His-BPT andMch-BPT were 90% and 83%,89% and 100%,89% and 93%,84% and 100%,93% and 90%respectively.②Area under the ROC curve of the His-BPT is 0.959,the 95% confidence interval （0.91 6-1.001）,P 〈0.01;The Mch-BPT is 0.957,the 95% confidence interval（0.901-1.013）,P 〈0.01;③The main adverse effect in asthmatic group with Mch-BPT or His-BPT were cough （His-BPT：64.29%, Mch-BPT：50%,P = 0.10）,throat-drying （His-BPT：57.14%,Mch-BPT：35.71%,P = 0.1 7）,short breath （His-BPT：82.14%,Mch-BPT：78.57%,P = 0.92）,chest tightness （His-BPT：32.14%, Mch-BPT：25%,P =0.40）respectively.The main adverse effect in CPI with Mch-BPT or His-BPT were cough（His-BPT：66%,Mch-BPT：44%,P 〈0.01）,throat-drying（His-BPT：43%,Mch-BPT：57%,P =0.47）,short breath（His-BPT：22%,Mch-BPT：1 9%,P =0.40）.The incidence of cough and hoarseness in healty volunteers with His-BPT were significantly higher than those in volunteers with Mch-BPT（67%vs 38%;P 〈0.01;29% vs 5%,P =0.05）.Conclusions Both of His-BPT and Mch-BPT showed a high diagnostic value and no severe adverse effect,but a higher specificty and lower sensitivity were found in Mch-BPT.Though a high rate of adverse effect was found in His-BPT,subjects with adverse effect could received relief after related management.It was worth promoting the use of His-BPT and Mch-BPT i
出处
《国际呼吸杂志》
2016年第21期1616-1621,共6页
International Journal of Respiration
基金
国家科技支撑计划项目（2013BA109809、2015BA112810）
广州医学院第一附属医院青年项目（y200905gyfy）
关键词
支气管激发试验
组胺
乙酰甲胆碱
不良反应
Bronchial provocation test
Histamine
Methacholine
Adverse effect
