成年轻度哮喘患者不同诊断测试的特征：与胃食管反流引起的哮喘样症状患者的比较。

The characteristics of different diagnostic tests in adult mild asthmatic patients: comparison with patients with asthma-like symptoms by gastro-oesophageal reflux.

作者信息

Di Lorenzo Gabriele, Mansueto Pasquale, Esposito-Pellitteri Maria, Ditta Vito, Castello Francesco, Lo Bianco Claudia, Leto-Barone Maria Stefania, Di Fede Gaetana, Traverso Marcello, Rotolo Giuseppe, Vigneri Sergio, Rini Giovambattista

机构信息

Dipartimento di Medicina Clinica e delle Patologie Emergenti, Università degli Studi di Palermo, Via del Vespro no. 141, 90127 Palermo, Italy.

出版信息

Respir Med. 2007 Jul;101(7):1455-61. doi: 10.1016/j.rmed.2007.01.014. Epub 2007 Mar 13.

DOI:10.1016/j.rmed.2007.01.014

PMID:17360170

Abstract

BACKGROUND

Diagnosing asthma cannot be always easy. It is important to consider the validity of the diagnostic tests, and/or how much more commonly they are positive in patients with asthma compared to healthy subjects and, particularly, to patients with asthma-like symptoms.

OBJECTIVE

To evaluate the validity of diagnostic tests for asthma, in terms of sensitivity, specificity, positive and negative predictive values, in patients with bronchial asthma compared to patients affected by gastro-oesophageal reflux disease (GERD) with asthma-like symptoms, and healthy control subjects without asthma and gastro-oesophageal reflux (GER).

DESIGN

Single-center, cross-sectional, observational study.

PATIENTS

We studied 60 patients with mild asthma, 30 patients with GERD and asthma-like symptoms and 25 healthy control subjects.

MEASUREMENTS

We measured provocative concentration of methacholine causing a 20% fall in the forced expiratory volume in 1s (MCh PC(20)/FEV(1)), the amplitude percent mean of peak expiratory flow (A%M of PEF), derived from twice-daily readings for >2 weeks, the FEV(1)/forced vital capacity (FEV(1)/FVC) ratio, the eosinophil count in blood and in induced sputum and the serum eosinophil cationic protein (ECP) levels.

RESULTS

FEV(1)/FVC ratio, A%M of PEF, blood eosinophils counts and serum ECP levels were less sensitive and specific when the reference population was composed of patients with asthma-like symptoms by GER. While, MCh PC(20)/FEV(1) and induced sputum eosinophils count were the most sensitive (both 90%) and specific (89% and 92%, respectively) tests.

CONCLUSION

Our findings demonstrate that MCh PC(20)/FEV(1) and the induced sputum eosinophil count are the most useful objective tests in patients with mild asthma. All patients with asthma presented both an MCh PC(20)/FEV(1) <1500 microg and eosinophils count in the induced sputum >1%.

摘要

背景

哮喘的诊断并非总是轻而易举。考虑诊断测试的有效性，以及与健康受试者相比，尤其是与有哮喘样症状的患者相比，这些测试在哮喘患者中呈阳性的频率更为重要。

目的

评估哮喘诊断测试在支气管哮喘患者与有哮喘样症状的胃食管反流病（GERD）患者以及无哮喘和胃食管反流（GER）的健康对照受试者中的敏感性、特异性、阳性和阴性预测值方面的有效性。

设计

单中心、横断面、观察性研究。

患者

我们研究了60例轻度哮喘患者、30例有GERD和哮喘样症状的患者以及25名健康对照受试者。

测量

我们测量了使一秒用力呼气量下降20%的乙酰甲胆碱激发浓度（MCh PC(20)/FEV(1)）、从>2周的每日两次读数得出的呼气峰值流速平均振幅百分比（A%M of PEF）、FEV(1)/用力肺活量（FEV(1)/FVC）比值、血液和诱导痰中的嗜酸性粒细胞计数以及血清嗜酸性粒细胞阳离子蛋白（ECP）水平。