一磷酸腺苷支气管激发试验的建立

目的 建立一磷酸腺苷(AMP)支气管激发试验的测定方法.方法 由低浓度至高浓度倍增剂量吸入AMP试剂,在吸药前及每次吸药后进行肺功能测定,以PD_(20)FEV_1-AMP<40 mg为判断阳性阈值.对24例健康志愿者(对照组),41例支气管哮喘患者(哮喘组)分别进行AMP支气管激发试验.分析两组的阳性率、PD_(20)FEV_1-AMP、敏感性、特异性、准确度及不良反应.结果 对照组AMP激发试验均为阴性,PD_(20)FEW_1-AMP均>40 mg;哮喘组中38例阳性,阳性率为92.7%,PD_(20)FEV_1-AMP为1.25 mg(6.98 mg).哮喘组的PD_(20)FEV_1-AMP和肺功能变化值△FEV_1、△FVC、APDF的相关系数分别为-0.619(P<0.01)、-0.447(P=0.003)、-0.352(P=0.024).AMP支气管激发试验的灵敏度、特异度和准确度分别为93%、100%和95%,出现喘息、气促、咳嗽和胸闷的哮喘患者分别有78%、29%、29%和10%,但程度较轻,无严重不良反应发生.结论 AMP支气管激发试验的敏感度、特异度、准确度高,可以作为有效诊断哮喘的辅助检查方法,且其安全性良好,本研究成功建立了AMP支气管激发试验的方法.

Establishment of adenosine monophosphate bronchial provocation test

Objective To establish adenosine monophosphate(AMP) bronchial provocation test (AMP-BPT)for the assessment of bronchial asthma(asthma).Methods Twenty-four heahhy nonsmoker volunteers(control group)and 41 patients of asthma(asthma group)were enrolled.AMP was nebulization inhaled from low to high concentration to achieve cumulative doubling dosage.Pulmonary function test was performed before and after each provocation dose.PD_(20)FEV_1-AMP<40 mg was set as a cut-off value to determine the positive response.Positive rate.PD_(20)FEV_1-AMP.sensitivity,specificity accuracy and adverse reactions of AMP provocation test were accessed.Results No positive response to AMP was found in control group,however,38 patients with asthma group(92.7%)responded to AMP with PD_(20) FEV_1-AMP as 1.25 mg(6.98 rag).There were negative correlations between PD_(20)FEV_1-AMP and the percentage change in FEV_1(r=-0.619,P<0.01).FVC(r=-0.447,P=0.003)and PEF(r=0.352,P=0.024).The sensitivity,specificity and accuracy was 93%,100%and 95%,respectively.Percentage of asthmatics who experienced wheezing,dyspnea,cough and chest tightness were 78%,29%,29%and 10%,respectiveiy,but no severe adverse reactions were found.Conclusions The high sensitivity,specificity and accuracy of AMP-BPT provide a useful,effective and safe test for the assessment of asthma.It is well toIerated.AMPBPT was successfully established.