论文部分内容阅读
目的:探讨Astograph法激发试验及小气道功能指标诊断哮喘的价值。方法:纳入2018年1月至2019年3月就诊于三家医院的哮喘患者86例，并以40例非哮喘患者作为对照组。受试者依次完成基本资料采集、脉冲震荡检查、肺常规通气功能、Astograph法激发试验。比较哮喘组与非哮喘组常规肺功能指标、脉冲振荡指标、反应阈值(Dmin)，并分析各指标间的相关关系。结果:哮喘组Dmin、用力呼气50%肺活量(余50%肺活量)的瞬间流量(MEFn 50)、用力呼气75%肺活量(余25%肺活量)的瞬间流量(MEFn 25)、最大呼气中段流速(MMEF)低于非哮喘组(n P0.05)。哮喘患者的Dmin与MEFn 50、MEFn 25、MMEF呈正相关(n r＝0.295、0.306、0.381，均n P<0.05)。Dmin诊断哮喘的曲线下面积(AUC)为0.978(95%n CI：0.950～1.000)，最佳截断值为13.609 Units，灵敏度和特异度分别为0.946和0.968。MEFn 50、MEFn 25、MMEF诊断哮喘的曲线下面积分别为0.674，0.738，0.683，最佳截断值分别为3.990 L、1.685 L、3.445 L。n 结论:Astograph法激发试验快速、安全、准确，适用于协助哮喘诊断。MEFn 50、MEFn 25可能与哮喘的诊断有关，能够预测气道高反应性。MMEF、MEFn 50和MEFn 25在哮喘的诊断意义优于脉冲振荡指标。n “,”Objective:To explore the value of Astograph challenge test and small airway functional parameters to diagnose asthma.Methods:86 asthmatics were enrolled along with 40 non-asthmatic patients as a control group from January 2018 to March 2019 in People′s Hospital of Nanhai Economic Development Zone, Foshan Chancheng District Central Hospital and Affiliated Hospital of Guangdong Medical University. All subjects were required to complete data acquisition, impulse oscillometry (IOS), pulmonary function test, and Astograph challenge test. The routine pulmonary function indexes, pulse oscillation indexes and reaction threshold (Dmin) were compared between asthma group and non asthma group, and the correlation between each index was analyzed.Results:The Dmin, max expiratory at 50% forced vital capacity (MEFn 50%), max expiratory at 75% forced vital capacity (MEFn 25%), maximal mid expiratory flow (MMEF) of asthma group were significantly lower than those of non-asthmatic group (n P0.05). Response threshold (Dmin) was positively correlated to MEFn 50, MEFn 25 and MMEF respectively (0.295, 0.306, 0.381, all n P<0.05). A receiver operating characteristic (ROC) analysis indicated the area under ROC curve (AUC) of Dmin in diagnosis of asthma was 0.978 (95%n CI: 0.950-1.000), the best cutoff point of Dmin was 13.609 Units, with sensitivity in diagnosing asthma 94.6%, specifity 96.8%. The AUC for MEFn 50, MEFn 25, MMEF were 0.674, 0.738, 0.683, with the best cutoffs 3.990 L, 1.685 L, 3.445 L, respectively.n Conclusions:Astograph challenge test, which is fast, safe and precise, can assist in the diagnosis of asthma. MEFn 50 and MEFn 25 may be associated with the diagnosis of asthma and can predict airway hyper-responsiveness while IOS parameters could not, which make MMEF, MEFn 50 and MEFn 25 superior to IOS parameters in the diagnosis of asthma.n