甲苯二异氰酸酯哮喘特异性诊断方法的改进

用自行设计的袋式吸入试验装置,对18例可疑甲苯二异氰酸酯(TDI)哮喘进行了TDI特异性吸入激发,确诊12例为TDI哮喘,其中速发型反应3例,迟发型反应6例,双向反应3例。吸入TDI后FEV_1,PEFR,V_(50)和V_(25)均有明显下降(P<0.01),提示TDI对大小气道的口径均有影响。用TDI和人血清白蛋白(HSA)交联剂作皮肤过敏试验,12例TDI哮喘中11例呈阳性;62例接触TDI但无呼吸道症状的工人中11例呈阳性;18例不接触TDI的普通哮喘患者均为阴性。因此,我们认为TDI-HSA皮试对TDI哮喘的诊断有辅助价值,但不能替代特异性吸入激发试验。并认为袋式吸入激发装置与方法,准确合理,且方便易行。

Improvement Method of Diagnosis in Toluene Diisocyanate Asthma

Using a self-made bag inhalation challenge device, we diagnosed 12 toluene diisocyanate ( TDI ) asthmatics, who were from 18 workers symptomatic of the disease. These 12 cases belonged to three types of airway reaction to TDI: three showed an immediate response, six were late, three were dual. After inhalation challenge, FEV1, PEFR, V50 and V25 descended obviously(P<0.01 ), suggesting that airway response to TDI in TDI asthmatic might occur in either larger or small airway. Patients were skin-tested with a toluene diisocyanate and human serum albumin conjugate(TDI-HSA). There were positive responses in 11 of the 12 TDI, asthmatics and in 11 of the 62 TDI workers who had no symptoms after exposure to TDI, and no one positive response in 18 common asthmatics. Therefore, TDI-HSA skin test can be used as an auxiliary diagnosis of TDI asthma, but can not replace the TDI inhalation challenge. This report demonstrated that the method and device of TDI challenge was precise, reasonable, convenient and easy to use.