Dal Negro Roberto Walter, Tognella Silvia, Micheletto Claudio, Sandri Marco, Guerriero Massimo
Lung Department, Ospedale Orlandi, Bussolengo, Italy.
J Asthma. 2009 May;46(4):351-5. doi: 10.1080/02770900802712955.
The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER-ve). Methods. Each subject performed an MCh challenge in baseline (MCh(b)), and 30 minutes after an acid drink (125 mL at pH = 2; MCh(ac)), one day apart. PD(20)FEV(1) MCh(b) and MCh(ac) were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU(4)), and PD(20)FEV(1) MCh(ac) (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 mu g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes.
胃食管反流（GER）对肺功能的直接影响仍存在争议。目的。探讨食管酸化在GER相关哮喘患者与特应性哮喘患者中对气道对乙酰甲胆碱（MCh）反应的影响作用，并评估相关事件的特异性和敏感性。对象。共56例从不吸烟的轻度哮喘患者：27例非特应性哮喘患者且有酸性GER（GER阳性），29例无任何GER的特应性哮喘患者（GER阴性）。方法。每位受试者在基线时（MCh(b)）以及饮用酸性饮料（pH = 2的125 mL，1天后；MCh(ac)）30分钟后进行MCh激发试验。通过估计ROC曲线下面积（AU-ROC）比较PD(20)FEV(1) MCh(b)和MCh(ac)。结果。GER阳性和GER阴性受试者（基线时匹配良好）食管酸接触持续时间不同（24小时监测；pH-24h AU(4)），且PD(20)FEV(1) MCh(ac)也不同（均p < 0.001）。AU-ROC为86.3%（76%至97%，95%CI）。变化的敏感性和特异性分别为82.8%（72.9%至92.7%，95%CI）和85.2%（75.9%至94.5%，95%CI）。使敏感性和特异性水平均最大化的MCh阈值差异为100μg。结论。食管酸化仅在存在酸性GER时通过增强MCh反应，以良好的敏感性和特异性水平识别出GER相关哮喘。数据支持该方法用于临床目的的有效性。
