改良中文版儿童呼吸和哮喘控制测试与全球哮喘防治创议标准控制分级的比较

Comparison between modified Chinese Version of Test for Respiratory and Asthma Control in Kids and Global Initiative for Asthma guideline

目的通过与全球哮喘防治创议(Global Initiative for Asthma,GINA)标准比较评估哮喘控制水平,探讨改良中文版儿童呼吸和哮喘控制测试(Test for Respiratory and Asthma Control in Kids,TRACK)在5岁以下儿童哮喘管理中的应用价值。方法纳入2018年3月至8月于青岛大学附属医院儿科门诊就诊的157例0~5岁哮喘患儿,由哮喘专家给予个体化抗哮喘治疗3个月,治疗结束后由哮喘专家根据GINA标准评估哮喘控制水平,监护人完成中文版TRACK问卷,通过受试者工作特征曲线(ROC曲线)分析,筛选TRACK问卷诊断哮喘控制分级的最佳界限值,并对2种评估方法进行一致性比较。结果根据GINA标准控制分级,入组哮喘患儿可分为3组:控制组59例、部分控制组52例及未控制组46例。治疗后的TRACK得分:哮喘控制组[90(85,95)分]、部分控制组[80(70,85)分]与未控制组[60(55,65)分]比较差异有统计学意义(H=101.740,P<0.001)。中文版TRACK诊断哮喘控制的ROC曲线下面积为0.909,最佳界限值为80分,敏感性为87.3%,特异性为73.5%。TRACK问卷与GINA标准的一致性检验Kappa值为0.553,一致率为77.1%。结论中文版TRACK可作为一种有效的评估工具,有助于0~5岁哮喘患儿的病情监测和管理。

Objective To explore the value of modified Chinese Version of Test for Respiratory and Asthma Control in Kids(TRACK) in the management of asthmatic children aged 0-5 years old by comparing with Global Ini-tiative for Asthma(GINA) guideline. Methods A total of 157 children aged 0-5 years old were enrolled at the Pedia-tric Asthma Outpatient Department of the Affiliated Hospital of Qingdao University from March to August 2018.All children were treated with individualized anti-asthma treatment for 3 months.After treatment, asthma experts assessed the level of asthma symptom control based on the GINA guideline, while caregivers of all children completed TRACK questionnaire.The optimal threshold of the TRACK questionnaire for asthma control was determined by analyzing receiver operating characteristic curve(ROC curve), and consistency of the 2 evaluation methods was compared. Results All enrolled children were divided into 3 groups based on GINA guideline: 59 children for the well controlled group, 52 children for the partly controlled group and 46 children for the uncontrolled group.There was a significant difference statistically in TRACK scores among the well controlled group [90(85, 95) scores], the partly controlled group [80(70, 85) scores] and the uncontrolled group [60(55, 65) scores] after treatment (H=101.740, P<0.001). Area under the ROC curve was 0.909 for diagnosing asthma control by the modified Chinese version of TRACK, with 80 scores for optimal threshold, 87.3% for sensitivity and 73.5% for specificity.The Kappa value of the consistency test between the TRACK questionnaire and the GINA guideline was 0.553, and consistency rate of these 2 evaluation methods was 77.1%. Conclusions The modified Chinese version of TRACK can be used as an effective assessment tool to monitor and manage asthmatic children aged 0-5 years.