运动激发试验与药物激发试验用于气道高反应性检测的比较及临床价值评估

Comparison of clinical application of exercise challenge test and methacholine challenge test in measurement of airway hyperresponsiveness

目的比较运动激发试验与药物激发试验用于气道高反应性检测的优劣,以得出更佳、更安全的用于气道高反应性的检测方法。方法选择经哮喘正规治疗后拟停药的哮喘患儿47例,对每名受试患儿先后进行运动和药物两种激发试验检测,并与金标准(PD20)相比较得出各自的敏感度,记录和观察两种激发试验过程中支气管痉挛症状发生情况。结果以PD20作为金标准,药物激发试验对中、重度气道高反应性患儿的检出敏感度(61%)明显高于运动激发试验(9%)(P<0.05),且药物激发试验与金标准的一致性较高(κ=0.614),而运动激发试验与金标准的一致性较差(κ=0.006);但药物激发试验中,哮喘患儿支气管痉挛症状发生率高,与咳嗽和胸闷发生率呈正相关(P<0.05)。结论测定经哮喘正规治疗后拟停药的患儿气道高反应性时,药物激发试验较运动激发试验敏感度高,但副反应发生率亦较高。

Objective To compare the advantages and disadvantages between exercise challenge test（ECT） and methacholine challenge test（MCT） in the measurement of airway hyperresponsiveness（AHR）, in order to identify a better and safer method to measure AHR. Methods Forty-seven children with controlled asthma after regular treatment were enrolled. ECT and MCT were performed for each child successively, and sensitivity was obtained through comparison with the golden standard（PD20）. The occurrence of bronchospasm symptoms during the two tests was recorded. Results Taking PD20 as the gold standard, in children with moderate or severe AHR, the sensitivity of MCT（61%） for the measurement of AHR was significantly higher than that of ECT（9%）（P〈0.05）. The consistency between MCT results and PD20 was relatively high（κ=0.614）, while the consistency between ECT results and PD20 was relatively low（κ=0.006）. However, in the MCT, the incidence of bronchospasm symptoms was high and positively correlated with the incidence of cough and chest distress（P〈0.05）. Conclusions MCT has a higher sensitivity for the measurement of AHR, but has a higher incidence of adverse events, compared with ECT in children with controlled asthma after regular treatment.