南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (06): 793-798.doi: 10.12122/j.issn.1673-4254.2020.06.04

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白三烯D4支气管激发试验在儿童气道高反应性检测中的应用价值

刘芳君，龚财惠，秦江蛟，符 州，刘 莎   

  • 出版日期:2020-06-20 发布日期:2020-06-20
  • 基金资助:

Leukotriene D4 bronchial provocation test for detection of airway hyper-responsiveness in children

  

  • Online:2020-06-20 Published:2020-06-20

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摘要： 目的 探讨白三烯D4（LTD4）支气管激发试验（BPT）在儿童气道高反应性（AHR）检测中的应用价值。方法 选取2017年11月~2018年8月在我院呼吸专科门诊随访的6~14岁患儿151例，其中哮喘缓解期患儿86例，急性支气管炎（急支）复查患儿65例。以上患儿按随机数字表法分为LTD4组和乙酰甲胆碱组（MCH组），LTD4组患儿共78例行LTD4-BPT，包括46例哮喘患儿和32例急支复查患儿；MCH组患儿共73例行MCH-BPT，包括40例哮喘患儿和33例急支复查患儿。LTD4组BPT阴性的哮喘患儿洗脱后再行MCH-BPT。记录两种BPT过程中患儿的主要不良反应。利用受试者工作特征(ROC)曲线对两种BPT的诊断学价值进行评估。结果 LTD4组与MCH组患儿基础肺功能检测结果无显著差异（P>0.05）。LTD4组哮喘患儿BPT阳性率（26.1%）明显低于MCH组（72.5%）（P<0.05）；LTD4组急支复查患儿BPT阳性率（3.1%）低于MCH组（15.2%）。LTD4组BPT阴性的哮喘患儿MCH-BPT的阳性率为58.8 %，分度以轻度、极轻度为主。LTD4组敏感性（0.2609）低于MCH组（0.725），其特异度（0.9688）稍高于MCH组（0.8485），LTD4组的ROC曲线下面积（0.635）低于MCH组（0.787）。BPT过程中，LTD4组哮喘患儿主要不良反应为咳嗽（34.8%）、气促（19.6%）、胸部紧缩感（15.2%）以及喘息（10.9%），其发生率明显低于MCH组（P<0.05），两种试验中均未发生严重不良反应。结论 LTD4-BPT在儿童临床应用中安全性高，与MCH-BPT特异性相似，但敏感性较低，诊断学价值较低，在儿童气道高反应性检测中的应用价值有限。

Abstract: Objective To explore the value of leukotriene D4 (LTD4) bronchial provocation test (BPT) in detection of airway hyper-responsiveness (AHR) in children. Methods A total of 151 children aged 6 to 14 years, including 86 in remission of asthma and 65 with acute bronchitis, who were followed up in our respiratory clinic between November, 2017 and August, 2018. The children were randomly divided into LTD4 group (78 cases) and methacholine (MCH) group (73 cases). In LTD4 group, the 78 children underwent LTD4-BPT, including 46 with asthma and 32 children having re-examination for previous episodes of acute bronchitis; in MCH group, the 73 children underwent MCH-BPT, including 40 with asthma and 33 with acute bronchitis. MCH-BPT was also performed in the asthmatic children in the LTD4 group who had negative responses to LTD4 after an elution period. The major adverse reactions of the children to the two BPT were recorded. The diagnostic values of the two BPT were evaluated using receiver-operating characteristic (ROC) curve. Results There was no significant difference in the results of basic lung function tests between LTD4 group and MCH group (P>0.05). The positive rate of BPT in asthmatic children in the LTD4 group was significantly lower than that in the MCH group (26.1% vs 72.5%; P<0.05). The positive rate of BPT in children with previous acute bronchitis in the LTD4 group was lower than that in the MCH group (3.1% vs 15.2%). The positive rate of MCH-BPT in asthmatic children had negative BPT results in LTD4 group was 58.8% , and their asthma was mostly mild. The sensitivity was lower in LTD4 group than in MCH group (0.2609 vs 0.725), but the specificity was slightly higher in LTD4 group (0.9688 vs 0.8485).The area under ROC curvein LTD4 group was lower than that in MCH group (0.635 vs 0.787). In children with asthma in the LTD4 group, the main adverse reactions in BPT included cough (34.8%), shortness of breath (19.6%), chest tightness (15.2%), and wheezing (10.9%). The incidence of these adverse reactions was significantly lower in LTD4 group than in MCH group (P<0.05). Serious adverse reactions occurred in neither of the two groups. Conclusion LTD4-BPT had high safety in clinical application of children and was similar to the specificity of MCH-BPT. However, it had low sensitivity, low diagnostic value, and limited application value in children’s AHR detection.