哮喘控制测试的临床应用适应证分析

Analysis of the clinical indications of asthma control test

目的探讨ACT在评价哮喘患者使用情况,以了解其临床适应范围。方法病人收自2007年12月至2008年12月,治疗1个月以上复诊患者120例,符合美国胸科协会诊断标准。由熟练ACT评估的医生对病人进行ACT评估。哮喘分类一为:支气管舒张实验阳性(BDT+)患者(按初次就诊时)和支气管激发实验阳性(BPT+)患者;分类二为基于疾病严重程度分为轻度持续哮喘和中重度哮喘。评价ACT在不同类型哮喘评价情况,分为三个等级:好》(4项目可以用以评估),一般(2-3项),不适合(《1项)。为进一步分析ACT在不同严重程度哮喘评价的敏感性,选择门诊初次诊断BDT+哮喘患者29例。按照FEV1%把疾病分为轻度、中度和重度哮喘,比较各组ACT差别。结果 BDT+组中评价好的48例,一般15例,不适合的5例;BPT+组中评价好的10例、一般15例,不适合的27例,两组具有显著差异(P<0.001);轻度哮喘45例:哮喘评价好的12例、一般15例、不适合的18例;中重度哮喘75例;哮喘评价好的50例,一般21,不适合的4例,两组具有显著差异(P<0.001)。轻度哮喘,包括部分咳嗽变异型哮喘、季节性哮喘很难用ACT来评估,对于呼吸困难、夜间憋醒、急救药物使用情况及对生活质量的影响难以评判。入选BDT+哮喘患者29例研究发现,ACT评分与FEV1%显著正相关(r=0.55,P=0.003)。ACT评分在轻、中度之间无显著差异(P>0.05),ACT评分在轻度与重度之间为P=0.009,在中度与重度之间为P=0.008。结论 ACT更适合评估BDT+哮喘病人或中重度哮喘病人,临床应用时必须考虑其适应范围。

Objective To investigate the clinical indications of asthma control test（ACT）.Methods A total of 120 asthmatic patients with a diagnosis in line with the American Thoracic Society criteria and treated forovera month were enrolled in this study.The patients were asked to complete a survey to assess their symptoms and asthma attacks,and ACT evaluation was conducted by physicians familiarwith ACT evaluation.The patients were classified into two groups based on the pulmonary function test（positive for bronchodilator test and provocation test） or based on disease severity（mild and moderate-to-severe asthma groups）.The effect of ACT evaluation was graded as good（no less than 4 item available forevaluation）,fair（2-3 items available） and poor（no more than 1 item）.To further analyze the ACT sensitivity in relation to different disease severity,29 asthmatic patients with an initial diagnosis and BDT positivity were included,and the ACT score of the patients with mild,moderate and severe asthma based on FEV1%were compared.Results In patients positive for bronchodilator test,good,fair and poorevaluation effects were found in 48,15,and 5 cases,as compared to 10,15,and 27 in those positive forprovocation test,respectively,showing significant differences between the two groups（P〈0.001）.In mild asthma group,good,fair and poorevaluation effects were found in 12,15,and 18 cases,respectively,significantly different from those in moderate-to-severe asthma group（50,21,and 4 cases,P〈0.001）.ACT scores showed a positive correlation to FEV1%in 29 patients with positive BDT（r=0.55,P=0.003）.ACT scores had no significant difference between mild and moderate asthma groups（P〉 0.05）,but showed significant differences between mild and severe groups（P=0.009） and between moderate and severe groups（P=0.008）.Conclusion ACT is more suitable forevaluating patients positive forbronchodilatortest orwith moderate to severe asthma.