Casadevall J, Ventura P J, Mullol J, Picado C
Servei de Pneumologia Hospital General, Vic, Spain.
Thorax. 2000 Nov;55(11):921-4. doi: 10.1136/thorax.55.11.921.
Nasal provocation tests with lysine-aspirin have recently been introduced for assessment of aspirin intolerant asthma. A study was undertaken to evaluate the usefulness of acoustic rhinometry, a new non-invasive technique, in the diagnosis of aspirin intolerant asthma/rhinitis.
Fifteen patients with aspirin intolerant asthma/rhinitis (nine women, mean (SD) age 54.7 (14) years), eight patients with aspirin tolerant asthma/rhinitis (three women, mean (SD) age 52.6 (7.8) years), and eight healthy subjects (two women, mean (SD) age 32.5 (9.7) years) were studied. All subjects were challenged with saline (0.9% NaCl) and 25 mg lysine acetylsalicylic acid (L-ASA) instilled into each nostril of the nose on two separate days. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. Symptoms and rhinometry curves were recorded at 10 minute intervals for three hours, one hour before challenge and two hours after challenge.
L-ASA challenge induced a significant increase in symptoms in patients with aspirin intolerant asthma/rhinitis. No differences in the clinical response were detected in those with aspirin tolerant asthma/rhinitis or healthy subjects. L-ASA challenge induced a significant decrease in nasal volume measured by acoustic rhinometry in aspirin intolerant patients. No differences were detected between the challenges in aspirin tolerant patients. If a 25% decrease in nasal volume is taken as the cut off point, the specificity of the test was 94% and the sensitivity reached 73%. The nasal challenge was well tolerated by all subjects.
Acoustic rhinometry may be used to study the nasal response to L-ASA. Nasal challenge with L-ASA is safe and can be used as a diagnostic test even in asthmatic patients with severe bronchial obstruction.
赖氨酸阿司匹林鼻激发试验最近已被用于评估阿司匹林不耐受性哮喘。本研究旨在评估一种新的非侵入性技术——鼻声反射测量法在诊断阿司匹林不耐受性哮喘/鼻炎中的作用。
对15例阿司匹林不耐受性哮喘/鼻炎患者（9名女性，平均（标准差）年龄54.7（14）岁）、8例阿司匹林耐受型哮喘/鼻炎患者（3名女性，平均（标准差）年龄52.6（7.8）岁）和8名健康受试者（2名女性，平均（标准差）年龄32.5（9.7）岁）进行了研究。所有受试者在两个不同的日子里，每侧鼻孔分别滴入生理盐水（0.9%氯化钠）和25毫克赖氨酸乙酰水杨酸（L-ASA）。根据鼻部症状（打喷嚏、瘙痒、分泌物和鼻塞）评估临床反应。通过鼻声反射测量法测量鼻部反应。在激发前1小时和激发后2小时，每隔10分钟记录症状和鼻声反射测量曲线，共记录3小时。
L-ASA激发试验使阿司匹林不耐受性哮喘/鼻炎患者的症状显著增加。在阿司匹林耐受型哮喘/鼻炎患者或健康受试者中未检测到临床反应的差异。L-ASA激发试验使阿司匹林不耐受患者通过鼻声反射测量法测得的鼻腔容积显著减小。在阿司匹林耐受患者的激发试验之间未检测到差异。如果将鼻腔容积减少25%作为截断点，该试验的特异性为94%，敏感性达到73%。所有受试者对鼻部激发试验耐受性良好。
鼻声反射测量法可用于研究鼻腔对L-ASA的反应。L-ASA鼻部激发试验是安全的，即使在患有严重支气管阻塞的哮喘患者中也可作为诊断试验。
