Weersink E J, vd Elshout F J, van Herwaarden C V, Folgering H
Department Pulmonology, University Hospital Oostersingel, Groningen, The Netherlands.
Respir Med. 1995 May;89(5):351-6. doi: 10.1016/0954-6111(95)90007-1.
The objective of this study was to compare bronchial challenge tests with two substances [histamine (H) and methacholine (M)] and two methods of measuring the effect parameter FEV1 and pulmonary impedance [with the forced oscillation technique (FOT)] in order to determine which test is the shortest, and gives the least (drug) load to the patient. Furthermore, it was considered whether the result of one type of challenge test could be transferred to the result of another type of test. It was hypothesized that, since the FOT technique requires no forced manoeuvres of the subjects and therefore does not affect the airway patency, there must be differences in the provocation concentrations for reaching the conventional thresholds of 20% decrease in FEV1 (PC20 FEV1) and 40% increase in airway resistance measured at 8 Hz oscillation frequency (PC40 Rrs8). It was further hypothesized that the interindividual correlations between thresholds for both drugs will be low, because both drugs set off different mechanisms for bronchoconstriction. Bronchial challenge tests were performed in 23 stable asthmatics (15 males and 8 females; mean +/- SD age 30.3 +/- 11.6 years). Their mean control FEV1 was 85.2 +/- 12.6% predicted. For both drugs, PC40 Rrs8 was three-fold lower than PC20 FEV1. The within-drug correlation between log PC20 FEV1 (H,M) and log PC40 Rrs8 (H,M) was quite good [r(H) = 0.73, r(M) = 0.68]. The between-drug correlation of log PC20 FEV1 (H) and log PC20 FEV1 (M) was equally good. However, the 'between-drug' correlation of log PC40 Rrs8 (H) and log PC40 Rrs8 (M) was low (r = 0.36).(ABSTRACT TRUNCATED AT 250 WORDS)
本研究的目的是比较使用两种物质(组胺(H)和乙酰甲胆碱(M))进行支气管激发试验,以及两种测量效应参数第一秒用力呼气容积(FEV1)和肺阻抗的方法(采用强迫振荡技术(FOT)),以确定哪种试验用时最短,且给患者带来的(药物)负荷最小。此外,还探讨了一种激发试验的结果是否可以转换为另一种试验的结果。研究假设,由于FOT技术无需受试者进行用力动作,因此不会影响气道通畅性,那么在达到FEV1下降20%(PC20 FEV1)的传统阈值和在8赫兹振荡频率下测得的气道阻力增加40%(PC40 Rrs8)时,激发浓度必然存在差异。进一步假设两种药物阈值之间的个体间相关性较低,因为两种药物引发支气管收缩的机制不同。对23名稳定期哮喘患者(15名男性和8名女性;平均±标准差年龄30.3±11.6岁)进行了支气管激发试验。他们的平均对照FEV1为预测值的85.2±12.6%。对于两种药物,PC40 Rrs8均比PC20 FEV1低三倍。log PC20 FEV1(H、M)与log PC40 Rrs8(H、M)之间的药物内相关性相当好[r(H) = 0.73,r(M) = 0.68]。log PC20 FEV1(H)与log PC20 FEV1(M)之间的药物间相关性同样良好。然而,log PC40 Rrs8(H)与log PC40 Rrs8(M)之间的“药物间”相关性较低(r = 0.36)。(摘要截选至250词)