系列PEF分析对职业性哮喘的诊断优于PEF变异率
2010/01/07
关键词： Oasys-2，职业性哮喘，峰流速；肺功能测定
尽管缺乏足够的证据，PEF变异已广泛地用于职业性哮喘的诊断，Park等近期进行了一项研究，比较职业性哮喘和非职业性哮喘患者的清晨/日间PEF平均变异，并以特异性致敏源激发试验验证，以评价这一技术对职业性哮喘的诊断效率。
研究分为两个部分：第一部分判定最大PEF变异率测定对职业性哮喘诊断的作用，而第二部分评价这种方法的敏感性和特异性，并以Oasys-2系统比较分析系列PEF数据。
第一部分研究发现，清晨/日间PEF变异率下降5 L·min–1具有较好的特异性。但在第二部分研究中，这一判定值对职业性哮喘诊断的敏感度和特异度分别为50%和90.9%。且在适当的特异度范围内，无法获得更为理想的敏感度。而采用线性判别分析方法（Oasys-2系统）分析系列PEF数据发现，系列PEF分析对职业哮喘的诊断敏感度和特异度分别为83.8%和90.9%；系列分析工作日/休息日的PEF数据，对职业性哮喘的诊断敏感度和特异度为66.7% 和100%。
根据研究结果，Park等认为清晨/日间PEF变异对于职业性哮喘的诊断敏感性较差，而系列PEF分析具有更大的诊断价值。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 34:574-578）
（Eur Respir J 2009; 34:574-578）
Serial PEF measurement is superior to cross-shift change in diagnosing occupational asthma
D. Park1, V. C. Moore1, C. B. S. G. Burge1, M. S. Jaakkola1,2, A. S. Robertson1,2 and P. S. Burge1,2
Keywords: Oasys-2, occupational asthma, peak expiratory flow, pulmonary function testing
Cross-shift measurements of peak expiratory flow (PEF) are commonly employed in the diagnosis of occupational asthma, although evidence for this approach is lacking. The current paper presents an evaluation of the technique.
Mean changes in PEF across morning/day shifts were compared between workers with occupational asthma, confirmed using specific challenge testing, and non-working asthmatics. Individuals were divided into a development set, used to identify the optimum cross-shift change for diagnosing occupational asthma, and an evaluation set, used to test the sensitivity and specificity of this value. Comparative analysis of serial PEF records was performed using the Oasys-2 computerised system.
A cross-shift decrease in PEF of 5 L·min–1 achieved acceptable specificity in the development set. Applied to the evaluation set, this cut-off had a specificity of 90.9% and a sensitivity of 50%. Sensitivity could not be improved without unacceptable compromise to specificity. Analysis of serial PEF records using linear discriminant analysis identified occupational asthma with a sensitivity of 83.3% and a specificity of 90.9%. Serial analysis using mean work/rest day PEF comparison had a sensitivity of 66.7% and a specificity of 100%.
Cross-shift changes in PEF in morning/day-shift workers have poor sensitivity in diagnosing occupational asthma, and are inferior to serial techniques.
Eur Respir J 2009; 34:574-578
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