Kussek Paulo, Rosario Filho Nelson Augusto, Cat Mônica
Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
J Bras Pneumol. 2006 May-Jun;32(3):195-201.
To assess airway hyperresponsiveness to 4.5% hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization.
A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15% was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L.
In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4%. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9%. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80% and 92%, respectively.
Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing hyperresponsiveness in children and adolescents.
评估气道对4.5%高渗盐水溶液的高反应性，并与通过其他支气管收缩剂激发试验所获得的结果进行比较，同时研究其与患者过敏致敏作用的关系。
开展了一项横断面实验研究，最初纳入85名受试者。排除部分受试者后，最终样本由62例患者组成，分为两组：哮喘研究组（n = 45）和无哮喘或过敏的对照组（n = 17）。使用超声雾化器雾化高渗盐水，依次给药0.5、1、2、4和8分钟，直至一秒用力呼气量相对于基线值下降 = 15%。采用免疫捕获法测定对粉尘螨特异性免疫球蛋白E水平，当> 0.35 kU/L时被视为阳性。
在出现反应的36例哮喘组受试者中，高渗盐水雾化后一秒用力呼气量的平均下降值为27.4%。对照组受试者（免疫球蛋白E < 0.35 kU/L）中无人对高渗盐水呈现阳性反应。对照组受试者的一秒用力呼气量平均值为9%。哮喘组9名受试者的支气管激发试验结果为阴性。特异性免疫球蛋白E水平升高的受试者中支气管激发试验阳性的频率更高，表明支气管高反应性与特异性免疫球蛋白E水平之间存在关联。该试验的敏感性和特异性分别为80%和92%。
高渗盐水支气管激发试验具有令人满意的敏感性和特异性。因此，除了是一种成本低且所需设备极少的检查方法外，它还是评估儿童和青少年高反应性的一种有用手段。
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