常规支气管激发试验实用性再评价的临床研究

An evaluation of safety and influence factor of bronchial provocation test with methacholine and histamine

目的 观察乙酰甲胆碱或组织胺支气管激发试验的安全性、实用性及其相关影响因素。方法 回顾性分析乙酰甲胆碱或组织胺支气管激发试验的临床资料,分析2种使用药物的安全性和试验过程中的不良事件,并对乙酰甲胆碱支气管激发试验阳性患者进行临床随访,了解其与临床诊断哮喘的一致性。结果患者支气管激发试验阳性率为23. 29%(3924例/16843例),组织胺组阳性率为33. 54%(2042例/6082例),乙酰甲胆碱组阳性率为17. 49%(1882例/10761例)。组织胺组支气管激发试验阳性率高于乙酰甲胆碱组,差异有统计学意义(P <0. 05)。组织胺激发试验的阳性率在吸烟者中更高(吸烟者为36. 50%,不吸烟者33. 00%,P <0. 05),乙酰甲胆碱激发试验的阳性率在女性中更高(女性18. 70%,男性15. 40%,P <0. 05)。仅有3例出现咳嗽和喘憋略症状加重未完成检查。乙酰甲胆碱支气管激发试验阳性与临床诊断支气管哮喘符合率为69. 11%。结论 应用乙酰甲胆碱或组织胺进行支气管激发试验安全、可行,对鉴别慢性咳嗽的病因和提高不典型支气管哮喘患者的诊断具有重要价值。

Objective To evaluate the safety and clinical value of bronchial provocation test with methacholine and histamine.Methods Medical records of patients with bronchial provocation test with methacholine or histamine were retrospectively reviewed and analyzed.Adverse events were observed during the process of test.The percents of positive and negative in bronchial provocation test with methacholine and histamine were summarized.Age,sex,smoking related analysis was made.Clinical follow-up was made with those positive bronchial provocation test with methacholine.Results The total positive rate of bronchial provocation test is 23.30%(3924/16843);the positive rate of histamine test was33.54%(2042/6082);the positive rate of methacholine test was17.49%(1882/10761).The positive rate of histamine test was significantly higher in smokers(36.50%in smokers,33.00%in nonsmokers,P<0.05),and that of methacholine test was significantly higher in females(18.70%in females,15.40%in males,P<0.05).There were only 3 patients presented with advanced cough and dyspnea.The coincidence rate between the positive rates of methacholine test and the clinical diagnosis of asthma was 69.11%.Conclusion Bronchial provocation test with methacholine and histamine is safe and practicable.This check isvery important in the etilogical diagnosis of chronic cough and chest tightness,can promote the diagnosis of atypical asthma,and also contribute to patient to treatment.