Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Asthma. 2021 Jul;58(7):883-891. doi: 10.1080/02770903.2020.1739704. Epub 2020 Mar 16.
Bronchial hyperresponsiveness (BHR) is a representative feature of asthma. Although methacholine and mannitol are commonly used for bronchial challenge tests, the optimal roles of the two agents for assessing BHR remain unclear. We compared the diagnostic performance of methacholine and mannitol in bronchial challenge tests.
A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. The sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary of the receiver-operating characteristic curve (HSROC) of the two agents for detecting BHR in asthma were pooled using meta-analysis. A meta-regression analysis was used to identify potential sources of heterogeneity within the selected studies.
We identified six studies comprising 565 patients. The pooled sensitivity, specificity, and DOR of methacholine were 0.61 (95%CI, 0.44-0.76), 0.93 (95%CI, 0.70-0.99), and 23.47 (95% CI, 2.51-219.89), respectively. The pooled sensitivity, specificity, and diagnostic odds ratio of mannitol were 0.50 (95%CI, 0.28-0.73), 0.97 (95% CI, 0.94-0.99), and 35.22 (95% CI, 8.82-140.62), respectively. The area under the HSROC for mannitol was higher than that for methacholine (0.97 vs. 0.81, < 0.01). Considerable between-study heterogeneity was present for sensitivity and specificity in studies of both index tests. Univariate meta-regression analysis revealed that age and sex of the study participants were probable sources of heterogeneity for specificity in studies of methacholine.
Although mannitol showed better diagnostic performance than methacholine for identifying BHR in asthma, substantial between-study heterogeneity necessitates caution when interpreting the data.
支气管高反应性（BHR）是哮喘的一个代表性特征。虽然乙酰甲胆碱和甘露醇常用于支气管激发试验，但这两种药物评估 BHR 的最佳作用仍不清楚。我们比较了乙酰甲胆碱和甘露醇在支气管激发试验中的诊断性能。
使用 MEDLINE、EMBASE 和 Cochrane 中心注册库进行系统文献检索。使用 meta 分析汇总了这两种药物在哮喘中检测 BHR 的敏感性、特异性、诊断比值比（DOR）和分层汇总受试者工作特征曲线（HSROC）。使用 meta 回归分析确定了所选研究中潜在的异质性来源。
我们确定了包含 565 例患者的 6 项研究。乙酰甲胆碱的合并敏感性、特异性和 DOR 分别为 0.61（95%CI，0.44-0.76）、0.93（95%CI，0.70-0.99）和 23.47（95%CI，2.51-219.89）。甘露醇的合并敏感性、特异性和诊断比值比分别为 0.50（95%CI，0.28-0.73）、0.97（95%CI，0.94-0.99）和 35.22（95%CI，8.82-140.62）。甘露醇的 HSROC 曲线下面积高于乙酰甲胆碱（0.97 比 0.81，<0.01）。两种指标检测的研究中，敏感性和特异性均存在较大的研究间异质性。单变量 meta 回归分析显示，乙酰甲胆碱研究中特异性的异质性可能与研究参与者的年龄和性别有关。
尽管甘露醇在识别哮喘中的 BHR 方面的诊断性能优于乙酰甲胆碱，但存在大量的研究间异质性，因此在解释数据时需要谨慎。
