Bohadana A B, Peslin R, Megherbi S E, Teculescu D, Sauleau E A, Wild P, Pham Q T
Institut National de la Santé et de la Recherche Médicale, Unité 420, Epidémiologie Santé Travail, Vandoeuvre-lès-Nancy, France.
Eur Respir J. 1999 Feb;13(2):295-300. doi: 10.1034/j.1399-3003.1999.13b13.x.
In population studies, the provocative dose (PD) of bronchoconstrictor causing a significant decrement in lung function cannot be calculated for most subjects. Dose-response curves for carbachol were examined to determine whether this relationship can be summarized by means of a continuous index likely to be calculable for all subjects, namely the two-point dose response slope (DRS) of mean resistance (Rm) and resistance at 10 Hz (R10) measured by the forced oscillation technique (FOT). Five doses of carbachol (320 microg each) were inhaled by 71 patients referred for investigation of asthma (n=16), chronic cough (n=15), nasal polyposis (n=8), chronic rhinitis (n=8), dyspnoea (n=8), urticaria (n=5), post-anaphylactic shock (n=4) and miscellaneous conditions (n=7). FOT resistance and forced expiratory volume in one second (FEV1) were measured in close succession. The PD of carbachol leading to a fall in FEV1 > or = 20% (PD20) or a rise in Rm or R10 > or = 47% (PD47,Rm and PD47,R10) were calculated by interpolation. DRS for FEV1 (DRSFEV1), Rm (DRSRm) and R10 (DRSR10) were obtained as the percentage change at last dose divided by the total dose of carbachol. The sensitivity (Se) and specificity (Sp) of DRSRm, DRS10 delta%Rm and delta%R10 in detecting spirometric bronchial hyperresponsiveness (BHR, fall in FEV1 > or = 20%) were assessed by receiver operating characteristic (ROC) curves. There were 23 (32%) "spirometric" reactors. PD20 correlated strongly with DRSFEV1 (r=-0.962; p=0.0001); PD47,Rm correlated significantly with DRSRm (r=-0.648; p=0.0001) and PD47,R10 with DRSR10 (r=-0.552; p=0.0001). DRSFEV1 correlated significantly with both DRSRm (r=0.700; p=0.0001) and DRSR10 (r=0.784; p=0.0001). The Se and Sp of the various FOT indices to correctly detect spirometric BHR were as follows: DRSRm: Se=91.3%, Sp=81.2%; DRSR10: Se=91.3%, Sp=95.8%; delta%Rm: Se=86.9%, Sp=52.1%; and delta%R10: Se=91.3%, Sp=58.3%. Dose-response slopes of indices of forced oscillation technique resistance, especially the dose-response slope of resistance at 10Hz are proposed as simple quantitative indices of bronchial responsiveness which can be calculated for all subjects and that may be useful in occupational epidemiology.
在人群研究中，大多数受试者无法计算出使肺功能显著下降的支气管收缩剂激发剂量（PD）。研究了卡巴胆碱的剂量反应曲线，以确定这种关系是否可以通过一个可能对所有受试者都可计算的连续指标来概括，即通过强迫振荡技术（FOT）测量的平均阻力（Rm）和10Hz时阻力（R10）的两点剂量反应斜率（DRS）。71例因哮喘（n = 16）、慢性咳嗽（n = 15）、鼻息肉（n = 8）、慢性鼻炎（n = 8）、呼吸困难（n = 8）、荨麻疹（n = 5）、过敏性休克后（n = 4）及其他杂症（n = 7）前来就诊的患者吸入了五剂卡巴胆碱（每剂320μg）。紧接着测量了FOT阻力和一秒用力呼气容积（FEV1）。通过内插法计算导致FEV1下降≥20%（PD20）或Rm或R10升高≥47%（PD47,Rm和PD47,R10）的卡巴胆碱激发剂量。FEV1（DRSFEV1）、Rm（DRSRm）和R10（DRSR10）的DRS通过最后一剂时的百分比变化除以卡巴胆碱的总剂量获得。通过受试者工作特征（ROC）曲线评估DRSRm、DRS10δ%Rm和δ%R10在检测肺量计支气管高反应性（BHR，FEV1下降≥20%）方面的敏感性（Se）和特异性（Sp）。有23例（32%）“肺量计”反应者。PD20与DRSFEV1密切相关（r = -0.962；p = 0.0001）；PD47,Rm与DRSRm显著相关（r = -0.648；p = 0.0001），PD47,R10与DRSR10相关（r = -0.552；p = 0.0001）。DRSFEV1与DRSRm（r = 0.700；p = 0.0001）和DRSR10（r = 0.784；p = 0.0001）均显著相关。各种FOT指标正确检测肺量计BHR的Se和Sp如下：DRSRm：Se = 91.3%，Sp = 81.2%；DRSR10：Se = 91.3%，Sp = 95.8%；δ%Rm：Se = 86.9%，Sp = 52.1%；δ%R10：Se = 91.3%，Sp = 58.3%。强迫振荡技术阻力指标的剂量反应斜率，尤其是10Hz时阻力的剂量反应斜率，被提议作为支气管反应性的简单定量指标，可用于所有受试者，且可能在职业流行病学中有用。
