中国南方人群中支气管扩张剂反应对哮喘的诊断准确性。

Diagnostic Accuracy of Bronchodilator Response for Asthma in a Population of South China.

机构信息

Department of Respiratory Medicine, National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.

出版信息

Adv Ther. 2018 Oct;35(10):1578-1584. doi: 10.1007/s12325-018-0783-0. Epub 2018 Sep 12.

DOI:10.1007/s12325-018-0783-0

PMID:30209751

Abstract

INTRODUCTION

A significant bronchodilator response is commonly defined as a 12% or greater and 200 ml or greater change in FEV from baseline according to the 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) criterion. A number of studies have shown that the ATS/ERS criterion has limitations in asthma diagnosis, and some experts have argued for correcting the criteria. The aim of this study is to investigate the diagnostic value of acute bronchodilator response for asthma in a Southern Chinese population.

METHODS

We prospectively evaluated 805 patients with obstructive lung disease (309 for asthma, 496 for non-asthma). Spirometry was performed according to the ATS/ERS guidelines. Data were analyzed by SPSS 18.0. The receiver-operating characteristic (ROC) curve was drawn to assess the diagnostic accuracy of the ATS/ERS criterion based on FEV. Linear regression was used to analyze the factors of FEV change.

RESULTS

The sensitivity and specificity of the acute bronchodilator test when judged by the ATS/ERS criteria (200 ml or higher and 12% improvement) were 68.6% and 78.2%, respectively. For the ATS/ERS criteria, the Youden Index, which comprehensively reflects the authenticity of a diagnostic test, was 46.8%. The absolute change of FEV positively correlated with baseline FEV and weight and negatively with age, while the percentage change of FEV was negatively correlated with baseline FEV, age and height and positively with weight. Compared with the different diagnostic values, when ∆FEV was 195 ml and ∆FEV% was 14%, the Youden Index was the largest (48.2%) and the diagnostic capability of the test the biggest.

CONCLUSIONS

The ATS/ERS criterion for acute bronchodilator response might not be completely suitable for asthma in the Chinese population.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (Registry ID: ChiCTR-DDT-14004976).

FUNDING

This work was supported by the National Natural Science Foundation of China (grant nos. 81670027, 81270080).

摘要

简介

根据 2005 年美国胸科学会（ATS）/欧洲呼吸学会（ERS）标准，通常将 12%或更大，200ml 或更大的 FEV 从基线的变化定义为显著的支气管扩张剂反应。多项研究表明，ATS/ERS 标准在哮喘诊断中存在局限性，一些专家认为需要对标准进行修正。本研究旨在探讨急性支气管扩张剂反应在华南人群哮喘诊断中的价值。

方法

我们前瞻性评估了 805 例阻塞性肺疾病患者（309 例哮喘，496 例非哮喘）。根据 ATS/ERS 指南进行肺量测定。数据采用 SPSS 18.0 进行分析。绘制受试者工作特征（ROC）曲线，评估基于 FEV 的 ATS/ERS 标准的诊断准确性。采用线性回归分析 FEV 变化的影响因素。

结果

根据 ATS/ERS 标准（200ml 或更高，12%改善）判断，急性支气管扩张试验的灵敏度和特异度分别为 68.6%和 78.2%。对于 ATS/ERS 标准，综合反映诊断试验真实性的约登指数为 46.8%。FEV 的绝对变化与基线 FEV 和体重呈正相关，与年龄呈负相关，而 FEV 的百分比变化与基线 FEV、年龄和身高呈负相关，与体重呈正相关。与不同诊断值相比，当 ∆FEV 为 195ml，∆FEV%为 14%时，约登指数最大（48.2%），试验诊断能力最大。