高渗盐水支气管激发试验对哮喘管理价值的研究

目的：探讨高渗盐水支气管激发试验在哮喘患者中的应用，了解其是否能够作为评估哮喘严重程度和监测治疗后哮喘控制情况的有效指标。方法：46例轻、中度哮喘的门诊患者，按照2010年全球哮喘防治创议（GINA）哮喘治疗方案进行规范治疗，分别于治疗前1天、治疗后6个月及治疗后12个月时进行组胺支气管激发试验、高渗盐水激发试验测试及ACT问卷调查．其中高渗盐水激发试验测试于组胺支气管激发试验测试后第2天进行。分析组胺、高渗盐水激发试验中的PD20值和ACT评分在12个月的治疗过程中的变化情况．了解组胺、高渗盐水激发试验中的PD20-FEV-和ACT评分的相关性。结果：治疗6个月后，PD20-FEV1-组胺较治疗前并无明显改变（P〉0．05），12个月后，较治疗前才有较明显上升（P〈0．05），而PD20-FEV1-高渗盐水则在治疗后6个月时已出现明显上升，到12个月时该上升趋势更加明显，与6个月时的PD20-FEV，也有显著性差异。ACT评分情况与高渗盐水类似。相关性方面．治疗6个月时，ACT评分变化情况与PD20 FEV1-组胺和PD20 FEV1-高渗盐水均无明显相关性；到12个月时，与PD20 FEV1-高渗盐水有一定相关性（r=0．359，P〈0．01），而与PD20 FEV1-组胺仍无明显相关性。结论：高渗盐水激发试验能够评估哮喘的严重程度和监测治疗后哮喘的控制情况，对治疗方案的选择有指导意义。但对哮喘症状的评估仍不能仅依赖于气道反应性高低的评判，ACT等症状问卷仍十分重要。

Significance of hypertonic saline bronchial provocation test for management of asthmatic patients

Objective：To evaluate the clinical significance of hypertonic saline bronchial provocation test （HSBPT） for the management of asthmatic patients, and to determine whether HSBPT could serve as a parameter for assessment of the disease severity and monitor the asthma control following the treatment. Methods： We recruited 46 patients with mild-to-moderate asthma who were receiving regular treatment based on 2010 global initiative for asthma guideline. All patients underwent Asthma Control Test, histamine BPT, HSBPT at day 1 prior to the treatment and at months 6 and 12 after treatment. For individual time points, the HSBPT was performed at day 2 following the histamine BPT. This entailed the analyses on the dynamic changes in PD20 for both BPTs and ACT during the 12-month treatment period, and the correlation between PD20 FEV1 and ACT score. Results： Regular treatment for 6 months （ P 〉 0.05）, but not 12 months （ P 〈 0.05 ）, did not result in marked amelioration in the PD20 for histamine BPT. In contrary, regular treatment for 6 months led to a markedly higher PD/0FEVl for HSBPT, which became more significant when assessed at month 12 （P 〈0.05 for month 12 vs. month 6）. This held true for findings regarding ACT. At month 6, there was no marked correlation between ACT scores and PD20 FEV1 for both BPTs. However, the PD20 FEV1 for hypertonic saline （ r = 0. 359, P 〈 0.01 ）, but not histamine, was correlated with ACT score at month 12. Conclusion： The HSBPT can serve as a technique for assessment of disease severity and monitoring asthma control following the treatment, pointing to the clinical significance for guiding decisions on selection of therapeutic protocols. However, the magnitude of airway hyperresponsiveness should not be the sole criterion for asthmatic symptoms, which warrants the use of ACT score.