摘要
目的比较白三烯D4（LTD4）支气管激发试验对不同控制状态支气管哮喘（简称哮喘）患者的诊断价值及安全性。方法对18例未控制、19例部分控制和19例完全控制状态、从未吸烟的哮喘患者和21例正常对照受试者进行LTD4支气管激发试验，记录累积激发剂量（PD20FEV1-LTD4）。比较各组FVC指标的变化量、PD20FEV1-LTD4的分布特点、诊断学指标以及不良反应的差异。结果除正常对照组激发前后FVC绝对值无差异（P〉0．05）外，其余各组肺功能指标差异有统计学意义（P值均〈0．01）。未控制与部分控制组PD20FEV1-LTD4几何均数（分别为0．268nmol和0．349nmol）明显低于完全控制组（1．600nmol）。ROC图显示未控制组的AUC（0．997）最高，部分控制组（0．971）次之，完全控制组（0．707）最低。哮喘控制状态越差，不良反应出现的比例越高；未控制组与部分控制组出现不良反应的严重程度明显高于完全控制组。无严重不良反应出现。结论哮喘控制状态与气道对LTD4气道反应性有关。除较高安全性外，LTD4支气管激发试验对未控制和部分控制哮喘患者有较高的诊断学价值。
Objective To compare the diagnostic value and safety of leukotriene D4 （LTD4） bronchial provocation test in asthmatic patients under different control status. Methods LTD4 bronchial provocation tests were performed on 18 uncontrolled （UC）, 19 partly controlled （PC） and 19 controlled （CC） asthmatics and 21 healthy controls. The cumulative dose （PDz0 FEV1-LTD4） was recorded. Variation in spirometry after bronchial provocation, distribution of PD20 FEV1-LTD4, diagnostic parameters and adverse events were compared. Results Major spirometric parameters, except for FVC （ P 〉0.05） ,differed significantly after LTD4 bronchial provocation （all P 〈0.05）. The geometric mean PD20 FEV1-LTD4 was much lower in UC and PC （0. 268 nmol and 0. 349 nmol, respectively） as compared with CC （1. 600 nmol）. Receiver operation characteristic curve （ROCC） displayed the highest diagnostic value in UC, followed by PC and CC （area under curve.. 0. 997,0. 971 and 0. 707, all P 〈 0.05）. Poorer asthma control was associated with a higher proportion of patients with adverse events. Compared with CC, patients in groups UC and PC had a higher magnitude of adverse events after bronchial provocation. No severe adverse event was reported. Conclusions Asthma control is associated with the airwayresponsiveness to LTD4. LTD4 bronchial provocation test is well-tolerated and particularly useful in uncontrolled and partly controlled asthmatic patients.
出处
《国际呼吸杂志》
2015年第23期1761-1767,共7页
International Journal of Respiration
基金
广东省自然科学基金面上项目（9152800001000019）
