人工支气管激发试验可靠性的研究

Study on Reliability of Artificial Bronchial Provocation Test

目的评价人工乙酰甲胆碱(MCH)支气管激发试验[通过肺部听诊进行气道高反应性(AHR)结果判断]的可靠性。方法选取2009年10月1日至12月30日于本院诊断为慢性咳嗽的88例年长儿童(6～12岁)为研究对象,采用MCH从低浓度(0.25mg/mL×2min)开始逐渐递增(浓度依次为0.5mg/mL,1mg/mL,2mg/mL,4mg/mL,8mg/mL和16mg/mL)进行人工支气管激发试验。每次雾化吸入药物后首先进行肺部听诊,再进行肺通气功能检查,肺部任何区域出现哮鸣音、血氧饱和度下降>5%或MCH浓度已达16mg/mL时终止激发试验。对肺通气功能测定和人工支气管激发试验2种方式判断结果进行比较(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并于患儿家属签署临床研究知情同意书)。结果本组88例患儿中,通过肺功能测定激发试验判断的阳性率为79.5%(70/88),通过肺部听诊的人工支气管激发试验判断阳性率为71.6%(63/88),肺功能测定判断为呈阴性患儿通过肺部听诊均判断为呈阴性。结论人工支气管激发试验方法可靠,灵敏度稍低于肺通气功能检查,具有一定假阴性,可作为不具备肺功能仪的医院完成支气管激发试验的一种替代手段。

Objective To evaluate reliability of artificial methacholine bronchial provocation test （ judging by auscultation of the lungs airway hyperresponsiveness ） .Methods 88patients in our hospital in accordance with the ＂ guidelines for the diagnosis and treatment of chronic cough in children ＂ for diagnosis of chronic cough in older children as a test object,with methacholine from low concentration gradually increasing concentrations of provocation test,every time the aerosolized medication after the first pulmonary auscultation and lung function,pulmonary any regional wheezing,oxygen saturation decreased more than 5% or MCH concentration has reached 16mg / mL termination of the excitation test.On the 2ways to judge the positive results were compared.Results According to pulmonary function to judge the positive rate was 79.5% by auscultation of the lungs,artificial test positive rate was 71.6%,and through the pulmonary function judgement for negtive cases were all judged negative to be negative for artificial method.Conclusions Artificial simple bronchial provocation test method is reliable,high specificity,sensitivity was slightly lower than the pulmonary function test results,there was some false negative results,but only for the 10%. It could be recommend as an alternative judgement methods of methacholine bronchial provocation test in hospital without the pulmonary function instrument.