Moscato G, Dellabianca A, Paggiaro P, Bertoletti R, Corsico A, Perfetti L
Postgraduate School of Allergology and Clinical Immunology, University of Pavia, Italy.
Monaldi Arch Chest Dis. 1993;48(1):23-8.
To assess the validity of peak expiratory flow (PEF), measured by means of a peak flow meter, in comparison to forced expiratory volume in one second (FEV1) for measuring the airway response during specific bronchial challenges, we registered PEF and FEV1 in a random sequence during 75 positive (decrease in FEV1 of > or = 15% from baseline) and 75 negative (decrease in FEV1 < 15% from baseline) challenges with chemicals or allergens. The correlation between PEF and FEV1 in terms of absolute values and of percentage of change from baseline was statistically highly significant (p < 0.001) in all challenges and in the different pattern of response, immediate, dual and late. Relative operating characteristic analysis showed that an absolute decrease in PEF of > or = 70 l.min-1 in the immediate and of > or = 80 l.min-1 in the late phase of the response (cut-off points) gave optimal discrimination between challenges with a bronchoconstrictive response (defined as a FEV1 decrease > or = 15% from baseline), and challenges without. These cut-off points, however, were highly specific (92 and 93.3%, respectively), but not as sensitive (70.6 and 61.1%, respectively), and smaller absolute changes in PEF from baseline do not exclude a bronchoconstrictive response. Our data suggest that PEF readings are a useful diagnostic tool in assessing the airway response during a specific bronchial challenge in asthmatics, although with some limitations. PEF readings can be used to monitor the late response to a challenge during the evening and the night if PEF readings are carefully considered in relation to clinical symptoms.
为了评估使用峰值流量计测量的呼气峰值流速（PEF）与一秒用力呼气容积（FEV1）相比，在特定支气管激发试验中测量气道反应的有效性，我们在75次阳性（FEV1较基线下降≥15%）和75次阴性（FEV1较基线下降<15%）的化学物质或过敏原激发试验中，以随机顺序记录了PEF和FEV1。在所有激发试验以及不同反应模式（即时、双相和迟发）中，PEF与FEV1的绝对值以及相对于基线的变化百分比之间的相关性在统计学上具有高度显著性（p<0.001）。相对操作特征分析表明，在反应的即时阶段PEF绝对值下降≥70 l.min-1以及在迟发阶段下降≥80 l.min-1（截断点），能够对有支气管收缩反应（定义为FEV1较基线下降≥15%）的激发试验和无支气管收缩反应的激发试验进行最佳区分。然而，这些截断点具有高度特异性（分别为92%和93.3%），但敏感性不高（分别为70.6%和61.1%），并且PEF相对于基线的较小绝对变化并不能排除支气管收缩反应。我们的数据表明，尽管存在一些局限性，但PEF读数在评估哮喘患者特定支气管激发试验期间的气道反应时是一种有用的诊断工具。如果结合临床症状仔细考虑PEF读数，PEF读数可用于监测晚间和夜间激发试验的迟发反应。
