Vandenplas O, Binard-Van Cangh F, Brumagne A, Caroyer J M, Thimpont J, Sohy C, Larbanois A, Jamart J
Service de Pneumologie, Cliniques universitaires de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
J Allergy Clin Immunol. 2001 Mar;107(3):542-7. doi: 10.1067/mai.2001.113519.
Natural rubber latex (NRL) has been increasingly identified as a cause of occupational asthma (OA).
We sought to examine the accuracy of the clinical history, immunologic tests, and assessment of nonspecific bronchial hyperresponsiveness in diagnosing OA caused by latex compared with that of the specific inhalation challenge (SIC).
Forty-five consecutive patients referred for investigation of possible OA caused by latex underwent a diagnostic protocol, including an open medical questionnaire, skin prick testing against latex, measurement of bronchial responsiveness to histamine, and inhalation challenge with latex gloves. Recorded clinical history was judged retrospectively by 4 physicians who were blinded for the results of other objective tests.
The clinical history, skin prick testing against NRL, and assessment of nonspecific bronchial hyperresponsiveness showed a high sensitivity (87%, 100%, and 90%, respectively) but a low specificity (14%, 21%, and 7%, respectively) when compared with the results of the SIC. Logistic regression analysis showed that combining the results of skin prick tests against latex with the clinical history enhanced the negative predictive value from 50% to 71%, whereas the positive predictive value remained virtually unchanged (75% vs 76%).
The clinical history and immunologic tests were the most useful procedures in diagnosing NRL-induced asthma, although combining the 2 procedures remained less accurate than SIC. Further examination of the predictive values of available tests is warranted to recommend diagnostic strategies that are specific to the various agents causing OA.
天然橡胶乳胶（NRL）已越来越多地被确认为职业性哮喘（OA）的病因。
我们试图研究临床病史、免疫检测以及非特异性支气管高反应性评估在诊断乳胶所致OA方面与特异性吸入激发试验（SIC）相比的准确性。
连续45例因可能的乳胶所致OA而转诊接受调查的患者接受了一项诊断方案，包括开放式医学问卷、针对乳胶的皮肤点刺试验、组胺支气管反应性测量以及乳胶手套吸入激发试验。4名对其他客观检测结果不知情的医生对记录的临床病史进行回顾性判断。
与SIC结果相比，临床病史、针对NRL的皮肤点刺试验以及非特异性支气管高反应性评估显示出较高的敏感性（分别为87%、100%和90%），但特异性较低（分别为14%、21%和7%）。逻辑回归分析表明，将针对乳胶的皮肤点刺试验结果与临床病史相结合可使阴性预测值从50%提高到71%，而阳性预测值基本保持不变（75%对76%）。
临床病史和免疫检测是诊断NRL诱导哮喘最有用的方法，尽管将这两种方法结合起来仍不如SIC准确。有必要进一步研究现有检测的预测价值，以推荐针对导致OA的各种因素的特异性诊断策略。
