干冷空气鼻激发试验诊断特发性鼻炎的研究

Study on the diagnosis of idiopathic rhinitis by cold dry air provocation

目的:采用干冷空气(CDA)鼻激发试验对特发性鼻炎(IR)患者进行激发前后的评估,对比2组的鼻黏膜高反应性差异,探讨CDA鼻激发试验对于IR的辅助诊断价值。方法:本研究共纳入北京同仁医院门诊就诊的IR患者17例(IR组),以及健康无鼻炎志愿者15例(对照组)。所有受试者均接受CDA鼻激发试验,试验前后完成症状评分、鼻声反射、鼻阻力评估。应用多因素Logistic回归和ROC曲线评价该试验对IR的诊断价值。结果:IR组经过CDA鼻激发试验后,鼻部症状总评分(TNSS)、总鼻阻力(TNR)、鼻腔最小横截面积(MCA)和鼻腔总容积(TNV)的变化值显著高于对照组。基于多因素Logistic回归和ROC曲线,建立了预测诊断模型Y=0.394×ΔTNSS-0.061×ΔTNV(%)+0.014×ΔTNV(%)-2.318,其曲线下面积为0.919。当Y>0.49时,敏感度和特异度分别为82.4%和84.6%。结论:IR患者经CDA激发后,鼻部症状显著加重,通气功能明显受限。CDA激发试验为辅助诊断IR提供了可能的方法,并将在未来研究中扩大样本量验证其临床应用价值。

Objective:This study aimed to compare the nasal response of cold dry air(CDA)provocation in patients with idiopathic rhinitis(IR)and healthy individuals,and further assess its ability in diagnosing IR.Method:CDA provocation was performed among 15 healthy volunteers and 17 IR patients from Beijing Tongren Hospital Outpatient Department.Nasal symptom scores,total nasal volume(TNV),total nasal resistance(TNR)and minimal cross-sectional area(MCA)were checked before and after the provocation.Logistic regression analysis and Receiver Operating Characteristic(ROC)curves were used in data evaluation.Result:Subjects in the IR group showed significantly larger changes after CDA provocation in total nasal symptom score(TNSS),total nasal resistance(TNR),minimal cross-sectional area(MCA)and total nasal volume(TNV),compared with healthy volunteers.We built a predictive model for IR,Y=0.394×ΔTNSS-0.061×ΔTNV(%)+0.014×ΔTNV(%)-2.318,whose area under curve was 0.919 based on multi-factor logistic regression and ROC curve.According to the Youden index,the cut-off criteria was set to be Y>0.49,when its sensitivity and specificity were 82.4%and 84.6%,respectively.Conclusion:Aggravated nasal symptoms and decreased nasal ventilation could be seen after CDA provocation in the IR population.The CDA provocation provides a possible method for assisting the diagnosis of IR,and we’ll expand the sample size in future research to verify its clinical application value.