Vogelmeier C, Baur X, Fruhmann G
Section of Pulmonary Medicine, Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Federal Republic of Germany.
Int Arch Occup Environ Health. 1991;63(1):9-13. doi: 10.1007/BF00406191.
We performed diisocyanate inhalation tests (maximal concentration, 20 ppb; exposure time, 1-2 h) using toluene diisocyanate (TDI, n = 15) and diphenylmethane diisocyanate (MDI, n = 7) as well as methacholine challenges in 19 workers who had a clinical history of TDI/MDI-induced asthma. Additionally we tested volunteers who had no previous contact with diisocyanates: 10 healthy individuals with a negative methacholine test and 14 patients with asthma and a positive methacholine test were exposed to TDI. In all, 1 of the normal volunteers and 3 of the patients with asthma unrelated to diisocyanates showed a positive airway reaction to TDI, and 13 of the 19 diisocyanate workers displayed a positive result in the TDI/MDI inhalation test; however, only 6 of these 13 individuals reacted to methacholine. Furthermore, 3 of the 6 patients with a negative TDI/MDI challenge test demonstrated a significant response to methacholine. We conclude that bronchial hyperreactivity as evaluated by the methacholine challenge test is not closely related to isocyanate-induced bronchoconstriction and, therefore, the metacholine challenge is only of limited diagnostic value in patients with suspected isocyanate-induced asthma.
我们对19名有甲苯二异氰酸酯（TDI，n = 15）和二苯基甲烷二异氰酸酯（MDI，n = 7）所致哮喘临床病史的工人进行了二异氰酸酯吸入试验（最大浓度，20 ppb；暴露时间，1 - 2小时）以及乙酰甲胆碱激发试验。此外，我们还对之前未接触过二异氰酸酯的志愿者进行了测试：10名乙酰甲胆碱试验阴性的健康个体和14名乙酰甲胆碱试验阳性的哮喘患者接触了TDI。总共，1名正常志愿者和3名与二异氰酸酯无关的哮喘患者对TDI呈现气道反应阳性，19名二异氰酸酯工人中有13名在TDI/MDI吸入试验中结果呈阳性；然而，这13人中只有6人对乙酰甲胆碱有反应。此外，6名TDI/MDI激发试验阴性的患者中有3名对乙酰甲胆碱有显著反应。我们得出结论，通过乙酰甲胆碱激发试验评估的支气管高反应性与异氰酸酯诱导的支气管收缩没有密切关系，因此，乙酰甲胆碱激发试验在疑似异氰酸酯诱导哮喘的患者中诊断价值有限。
