哮喘控制测试前三项在判断支气管哮喘控制水平的价值

Value of the first 3 items of asthma control test for assessing the level of bronchial asthma control

目的评价哮喘控制测试（ACT）前三项（ACT-3）与ACT在判断支气管哮喘（简称哮喘）控制水平时的一致性，以获得更为简便的哮喘控制评估方法。方法研究对象为南方医院门诊诊断为哮喘的患者102例，患者正在接受或未接受规范化哮喘治疗。所有患者完成ACT评分及肺功能检查。ACT评分≤19分定义为哮喘未控制，ACT评分≥20分定义为良好控制。分析ACT与ACT-3两者的相关性及与肺功能各指标的相关性，分析ACT与ACT-3判断哮喘未控制的价值，并通过kappa系数评价ACT-3与AcT判断的吻合度。结果入选的患者ACT-3与ACT的相关系数为0．919（P=0．000）。ACT-3、ACT分别于肺功能指标第1秒用力呼气容积（FEV。）、FEV。占预计值百分比（FEV1％pred）等肺功能指标呈正相关，相关系数差异均有统计学意义。ACT-3判断哮喘未控制的ROC曲线下面积（AUC）为0．974（P=0．000）。当ACT-3≤11分时，为最佳截断点，判断哮喘未控制的敏感性为94．52％，特异性为93．10％。ACT-3≤11分和AcT≤19分判断哮喘未控制的一致性检验：kappa系数=0．858（P：0．000）。结论ACT～3能用于评价哮喘患者控制水平，以ACT-3≤11识别哮喘未控制时与ACT≤19有极高的一致性。当ACT无法完整获取时可以考虑使用ACT-3。

Objective To investigate the value of the first 3 items of asthma control test （ACT-3） for evaluating level of asthma control. Methods ACT were administered to 102 asthma patients from Nanfang Hospital. Spirometry was also used. Uncontrolled asthma was defined as ACT≤19, and well controlled asthma was defined as ACT^20. The correlation analysis between ACT, ACT-3 and the lung funcion indexes were conducted, respectively. The property of ACT-3 for identifying the uncontrolled asthma was evaluated using receiver operator characteristic （ROC） curve. And then, the agreement between ACT-3 and ACT for identifying the uncontrolled asthma was determined using kappa coefficient. Results The coefficient of correlation between the ACT-3 and ACT was 0. 919 （P = 0. 000）. Statistically significant positive correlation were observed between the ACT-3, ACT and lung funcion indexes such as forced expiratory volume in one second （FEV1）, percent predicted of FEV1, respectively. The areas under the ROC curve of ACT-3 for identifying the uncontrolled asthma was 0. 974 （P = 0. 000）. The optimal cutoff level of ACT-3 to discriminate between uncontrolled and well controlled asthma was 11 scores, giving 94.52% sensitivity and 93.10% specificity, respectively. Kappa coefficient showed a strong agreement between ACT-3 and ACT （kappa= 0. 858, P = 0. 000）. Conclusions The ACT-3 is able to assess the level of asthma control, and there＇s a strong agreement between ACT-3≤11 and ACT≤19 for identifying the uncontrolled asthma. ACT-3 may be a good choice when the full ACT is not available.