通过喘息和血氧饱和度对学龄前哮喘儿童进行乙酰甲胆碱激发试验。

Methacholine challenge test by wheezing and oxygen saturation in preschool children with asthma.

作者信息

Caussade S, Castro-Rodriguez J A, Contreras S, Bugueño R, Ramirez R, Padilla O, Einisman H, Holmgren N

机构信息

Department of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.

出版信息

Allergol Immunopathol (Madr). 2015 Mar-Apr;43(2):174-9. doi: 10.1016/j.aller.2014.02.005. Epub 2014 Jun 16.

DOI:10.1016/j.aller.2014.02.005

PMID:24948183

Abstract

UNLABELLED

Methacholine challenge test (MCT) performed with spirometry is a commonly used test to evaluate bronchial hyperreactivity (BHR) in children. However, preschoolers do not usually collaborate.

OBJECTIVES

To assess the usefulness of MCT through clinical evaluation (wheezing auscultation and decreased pulse arterial oxygen saturation [SpO2]) in recurrent wheezing preschoolers with asthma, in comparison to healthy controls.

METHODS

We performed the MCT (modified Cockroft method) on healthy and on asthmatic preschoolers. The end point was determined by the presence of wheezing in the chest and/or tracheal auscultation (PCw) and/or a decrease in SpO2 of ≥5 from the baseline value (PCSpO2). Maximal methacholine concentration was 8 mg/ml.

RESULTS

The study population comprised 65 children: 32 healthy and 33 asthmatic children. There were no differences in demographic characteristics between the groups. The median methacholine doses for PCw and for PCSpO2 were significantly lower among asthmatic than healthy children: 0.5 mg/ml (0.25-0.5 mg/ml) vs. 2 mg/ml (1-4 mg/ml), respectively, p<0.001; and 0.25 mg/ml (0.25-0.5 mg/ml) and 2 mg/ml (0.5-4 mg/ml), respectively, p<0.001. The best cut-off point of PCw was observed at a methacholine concentration of 0.5 mg/ml (AUC=0.72 [95% CI=0.66-0.77]), its sensitivity was 91%, specificity 43%, PPV 16% and NPV 98%. For PCSpO2 the best cut-off point was a methacholine concentration of 1 mg/ml (AUC=0.85 [95% CI 0.81-0.89]), with sensitivity of 80%, specificity 74%, PPV 49%, and NPV 92%. There were no adverse reactions.

CONCLUSION

MCT using clinical parameters such as wheezing auscultation and SpO2 measurement could be a useful and safe test to confirm BHR among preschoolers.

摘要

未标注

通过肺活量测定法进行的乙酰甲胆碱激发试验（MCT）是评估儿童支气管高反应性（BHR）常用的试验。然而，学龄前儿童通常不配合。

目的

与健康对照相比，通过临床评估（哮鸣音听诊和动脉血氧饱和度[SpO2]降低）评估MCT在复发性喘息学龄前哮喘儿童中的实用性。

方法

我们对健康和哮喘学龄前儿童进行了MCT（改良Cockroft法）。终点由胸部哮鸣音和/或气管听诊（PCw）的出现和/或SpO2较基线值降低≥5确定（PCSpO2）。最大乙酰甲胆碱浓度为8mg/ml。

结果

研究人群包括65名儿童：32名健康儿童和33名哮喘儿童。两组间人口统计学特征无差异。哮喘儿童中PCw和PCSpO2的乙酰甲胆碱剂量中位数显著低于健康儿童：分别为0.5mg/ml（0.25 - 0.5mg/ml）和2mg/ml（1 - 4mg/ml），p<0.001；以及分别为0.25mg/ml（0.25 - 0.5mg/ml）和2mg/ml（0.5 - 4mg/ml），p<0.001。PCw的最佳截断点在乙酰甲胆碱浓度为0.5mg/ml时观察到（AUC = 0.72 [95%CI = 0.66 - 0.77]），其敏感性为91%，特异性为43%，阳性预测值为16%，阴性预测值为98%。对于PCSpO2，最佳截断点是乙酰甲胆碱浓度为1mg/ml（AUC = 0.85 [95%CI 0.81 - 0.89]），敏感性为80%，特异性为74%，阳性预测值为49%，阴性预测值为92%。无不良反应。