Sistek D, Wickens K, Amstrong R, D'Souza W, Town I, Crane J
Department of Pneumology, Centre Hospitalier Universitaire Vaudois, CHUV, Rue du Bugnon 44, 1011 Lausanne, Switzerland.
Respir Med. 2006 Dec;100(12):2107-11. doi: 10.1016/j.rmed.2006.03.028. Epub 2006 May 30.
Respiratory symptoms are often used as the only diagnostic criteria for asthma in epidemiological surveys and the clinical diagnosis of asthma relies primarily on a detailed history. The aim of this study is to predict the diagnostic value of 11 different respiratory symptoms to diagnose asthma, and to determine if bronchial hyperresponsiveness (BHR) improves the predictive value of these respiratory symptoms. A random sample of 1257 subjects aged 20-44 years old in 3 different areas of New Zealand were selected between March 1991 and December 1992 to answer the European Community Respiratory Health Survey questionnaire on respiratory symptoms. Of these, 784 underwent bronchial challenge with methacholine. The prevalence of current doctor diagnosed asthma (DDA) defined as asthma confirmed by a physician and an asthma attack in the last 12 months was 8.3%. Wheezing with dyspnoea is the single best predictor of diagnosed asthma with a sensitivity of 82%, a specificity of 90% and a Youden's index of 0.72. Wheezing alone is more sensitive (94%) but less specific (76%), with a Youden's index of 0.70. The addition of BHR to asthma symptoms decreases sensitivity and increases specificity with a small increase in Youden's index to 0.75. In New Zealand adults, a history of wheezing with BHR best predicts a diagnosis of asthma but wheezing alone or with dyspnoea are the two best symptoms for predicting asthma.
在流行病学调查中，呼吸道症状常被用作哮喘的唯一诊断标准，而哮喘的临床诊断主要依赖详细病史。本研究旨在预测11种不同呼吸道症状对哮喘诊断的价值，并确定支气管高反应性（BHR）是否能提高这些呼吸道症状的预测价值。1991年3月至1992年12月期间，从新西兰3个不同地区随机抽取了1257名年龄在20 - 44岁之间的受试者，让他们回答关于呼吸道症状的欧洲共同体呼吸健康调查问卷。其中，784人接受了乙酰甲胆碱支气管激发试验。当前由医生诊断为哮喘（DDA）的患病率，即由医生确诊且在过去12个月内有哮喘发作的患病率为8.3%。伴有呼吸困难的喘息是诊断哮喘的最佳单一预测指标，敏感性为82%，特异性为90%，约登指数为0.72。单纯喘息更敏感（94%）但特异性较低（76%），约登指数为0.70。将BHR添加到哮喘症状中会降低敏感性并提高特异性，约登指数小幅增加至0.75。在新西兰成年人中，有BHR的喘息病史最能预测哮喘诊断，但单纯喘息或伴有呼吸困难是预测哮喘的两个最佳症状。
