目的 探討一磷酸腺苷( AMP) 支氣管激發(fā)試驗(yàn)在哮喘中的臨床應(yīng)用價(jià)值。方法 納入健康志愿者24 例( 正常對(duì)照組) , 哮喘患者60 例[ 哮喘未控制組19 例、部分控制組22 例、完全控制組19 例] , 急性上呼吸道感染患者20 例( 上炎組) 。均進(jìn)行AMP 支氣管激發(fā)試驗(yàn)。分析各組FEV1下降20% 時(shí)AMP 累積劑量( PD20 FEV1 -AMP) 、激發(fā)試驗(yàn)敏感性、特異性及不良反應(yīng)。隨訪23 例患者( 未控制組11 例和部分控制組12 例) , 分別予以規(guī)范吸入ICS 治療3 和6 個(gè)月后再次行AMP 支氣管激發(fā)試驗(yàn), 并在每次試驗(yàn)前1 周行哮喘癥狀評(píng)分。分析PD20FEV1-AMP值與哮喘癥狀評(píng)分的相關(guān)性。PD20FEV1-AMP數(shù)據(jù)以中位數(shù)( 四分位間距) [ M( QR ) ] 表示。結(jié)果 對(duì)照組陽(yáng)性率為0( 0 /24) ; 哮喘未控制組陽(yáng)性率為100% ( 19/19) , 哮喘部分控制組陽(yáng)性率為86. 4% ( 19/22) , 哮喘完全控制組陽(yáng)性率為26. 3%( 5 /19) ; 上炎組陽(yáng)性率為0( 0 /20) 。對(duì)照組和上炎組的PD20 FEV1-AMP 均 gt;40 mg; 哮喘未控制組、部分控制組、完全控制組的PD20 FEV1-AMP 分別為0. 6 mg( 0. 4 mg) 、5. 38 mg( 32. 67 mg) 、40 mg( 29. 3 mg) 。AMP支氣管激發(fā)試驗(yàn)的靈敏度、特異度分別為72% 、100%。lgPD20 FEV1-AMP 與哮喘癥狀評(píng)分的對(duì)數(shù)呈負(fù)相關(guān)( r = - 0. 598, P lt; 0. 01) 。不良反應(yīng)包括喘息( 37. 5% ) 、咳嗽( 21. 2% ) 、氣促( 15. 4% ) 、咽部刺激感( 7.7%) 、胸悶( 7.7%) 、咳痰( 4.8%) 、發(fā)紺( 1.0%) 。結(jié)論 AMP 支氣管激發(fā)試驗(yàn)?zāi)軌蛟\斷和鑒別診斷哮喘, 評(píng)估哮喘的嚴(yán)重程度和控制情況, 監(jiān)測(cè)哮喘的治療療效, 對(duì)哮喘治療方案有指導(dǎo)性意義, 且不良反應(yīng)輕微, 具有較好的臨床應(yīng)用前景。
引用本文： 吳凡,鄭勁平,高怡,安嘉穎,謝燕清,劉文婷,虞欣欣. 哮喘患者一磷酸腺苷支氣管激發(fā)試驗(yàn)的臨床應(yīng)用價(jià)值. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2009, 09(6): 558-564. doi: 復(fù)制
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| 3. | Sterk PJ, Fabbri LM, Quanjer PH, et al. Airway responsiveness:standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults: statement of the European Respiratory Society. Eur Respir J Suppl, 1993, 6( suppl) : 53-83. |
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| 5. | 鄭勁平. 間接性支氣管激發(fā)試驗(yàn)的研究進(jìn)展. 醫(yī)師進(jìn)修雜志,2005, 28( 8A) : 7-10. |
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| 8. | Joos GF. Indirect bronchial provocation tests: a new, specific group of bronchial provocation tests for asthma. Verh K Acad Geneeskd Belg, 2005, 67: 153-167. |
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| 11. | Polosa R, Holgate ST. Adenosine bronchoprovocation: a promising marker of allergic inflammation in asthma? Thorax, 1997, 52: 919 -923. |
| 12. | Cushley MJ, Tattersfield AE, Holgate ST. Inhaled Adenosine and Guanosine on airway resistance in normal and athma subjects. Br J clin Pharmacol, 1983, 15: 161-165. |
| 13. | Hogg JC, James AL, Pare PD. Evidence for inflammation in asthma.Am Rev Respir Dis, 1991, 143: S39-S42. |
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| 17. | 沈華浩, 應(yīng)英華. 新版全球哮喘防治創(chuàng)議( GINA) 方案的評(píng)價(jià)和解讀. 臨床內(nèi)科雜志, 2007, 24: 221-223. |
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- 1. 鄭勁平. 支氣管哮喘的肺功能特點(diǎn)及臨床意義. 見(jiàn): 鄭勁平, 陳榮昌, 主編. 肺功能學(xué)———基礎(chǔ)與臨床. 廣州: 廣東科學(xué)技術(shù)出版社, 2007, 362-369.
- 2. Rogers DF, O′Connor BJ. Airway hyperresponsiveness: relation to asthma and inflammation? Thorax, 1993, 48: 1095-1096.
- 3. Sterk PJ, Fabbri LM, Quanjer PH, et al. Airway responsiveness:standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults: statement of the European Respiratory Society. Eur Respir J Suppl, 1993, 6( suppl) : 53-83.
- 4. American Thoracic Society. Guidelines for methacholine and exercise challenge testing-1999. Am JRespir Crit Care Med , 2000 ,161: 309-329.
- 5. 鄭勁平. 間接性支氣管激發(fā)試驗(yàn)的研究進(jìn)展. 醫(yī)師進(jìn)修雜志,2005, 28( 8A) : 7-10.
- 6. Joos GF, O′Connor B, Anderson SD, et al. Indirect airway challenges: statement of the European Respiratory Society. Eur Respir J , 2003, 21: 1050-1068.
- 7. Van Schoor J, Joos GF, Pauwels RA. Indirect bronchial hyperresponsiveness in asthma: mechanisms, pharmacology and implications for clinical research. Eur Respir J, 2000, 16 : 514 -533.
- 8. Joos GF. Indirect bronchial provocation tests: a new, specific group of bronchial provocation tests for asthma. Verh K Acad Geneeskd Belg, 2005, 67: 153-167.
- 9. 周賢梅. 一磷酸腺苷支氣管激發(fā)試驗(yàn)研究現(xiàn)狀. 江蘇臨床醫(yī)學(xué)雜志, 2002, 6: 291-294.
- 10. Lee DKC, Gray RD, Lipworth BJ. Adenosine monophosphate bronchial provocation and the actions of asthma therapy. Clin Exp Allergy, 2003, 33: 287-294.
- 11. Polosa R, Holgate ST. Adenosine bronchoprovocation: a promising marker of allergic inflammation in asthma? Thorax, 1997, 52: 919 -923.
- 12. Cushley MJ, Tattersfield AE, Holgate ST. Inhaled Adenosine and Guanosine on airway resistance in normal and athma subjects. Br J clin Pharmacol, 1983, 15: 161-165.
- 13. Hogg JC, James AL, Pare PD. Evidence for inflammation in asthma.Am Rev Respir Dis, 1991, 143: S39-S42.
- 14. 李國(guó)順, 任壽安, 張曉云. 氣道高反應(yīng)性的臨床評(píng)價(jià). 中華結(jié)核和呼吸雜志, 1994, 17: 216.
- 15. 趙桂華, 潘金兵, 王煥霞. 支氣管激發(fā)試驗(yàn)陽(yáng)性結(jié)果分析. 中原醫(yī)刊, 2007, 34: 9-10.
- 16. 李黎, 孫春香. 支氣管高反應(yīng)性的臨床評(píng)價(jià). 山西醫(yī)科大學(xué)學(xué)報(bào), 1998, 29: 138-139.
- 17. 沈華浩, 應(yīng)英華. 新版全球哮喘防治創(chuàng)議( GINA) 方案的評(píng)價(jià)和解讀. 臨床內(nèi)科雜志, 2007, 24: 221-223.
- 18. 趙志強(qiáng), 王金平, 王長(zhǎng)征, 等. 支氣管激發(fā)試驗(yàn)的臨床試驗(yàn). 臨床內(nèi)科雜志, 2005, 22: 785.