小气道功能指标联合血嗜酸性粒细胞、总免疫球蛋白E在轻度哮喘诊断中的价值OA
The value of small airway function indexes combined with blood eosinophils and total im-munoglobulin E in the diagnosis of mild asthma
目的 探讨小气道功能指标联合血嗜酸性粒细胞(EOS)、总免疫球蛋白E(总IgE)对轻度哮喘的诊断价值.方法 纳入2023年12月至2024年11月中国人民解放军北部战区总医院呼吸内科因喘息、气促、胸闷、咳嗽就诊患者415例,所有患者均接受支气管激发试验检查,根据检查结果将阳性者纳入哮喘组(124例),将阴性者纳入非哮喘组(291例),分析两组患者小气道功能指标、EOS、总IgE表达水平的差异并进行相关性分析,探讨三者对轻度哮喘的单独诊断价值及联合诊断价值.结果 哮喘组的EOS、总IgE水平明显高于非哮喘组(P＜0.001);哮喘组第1秒用力呼气容积占预计值百分比(FEV1％pred)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、用力呼气50％肺活量的瞬间流量占预计值百分比(FEF50％pred)、用力呼气75％肺活量的瞬间流量占预计值百分比(FEF75％pred)、最大呼气中期流量占预计值百分比(MMEF％pred)均明显低于非哮喘组(P＜0.001).应用EOS、总IgE及小气道功能指标构建21个预测模型,结果显示上述指标对轻度哮喘均有一定的诊断效能(P值均＜0.001),且指标联合更优,基于EOS、总IgE、FEF50％pred、FEF75％pred及MMEF％pred构建的模型为最佳诊断模型,曲线下面积(95％置信区间)为[AUC(95％CI):0.888(0.855～0.920)],灵敏度为86.29％,特异度为77.32％.结论 联合应用小气道功能指标、EOS及总IgE对轻度哮喘有一定的诊断价值,且较支气管激发试验更简便、经济、安全,适合基层医院初筛.
Objective To investigate the diagnostic value of small airway function indexes combined with blood eosinophil(EOS)and total immunoglobulin E(total IgE)levels for mild asthma.Methods 415 patients with wheezing,shortness of breath,chest tightness,or cough were enrolled in the Department of Re-spiratory Medicine,General Hospital of Northern Theater Command,PLA,from December 2023 to November 2024.All patients underwent a bronchial provocation testbased,on the test results,those with positive results were assigned to the asthma group(124 cases),and those with negative results were assigned to the non-asth-ma group(291 cases).Differences in small airway function indexes,EOS,and total IgE levels between the two groups and their correlations were analyzed.The individual and combined diagnostic values of these parame-ters for mild asthma were evaluated.Results EOS and total IgE levels in the asthma group were significantly higher than those in the non-asthma group(P＜0.001).The asthma group showed significantly lower values for forced expiratory volume in 1 second as a percentage of predicted(FEV1％pred),FEV1/forced vital ca-pacity(FEV1/FVC),forced expiratory flow at 50％of vital capacity as a percentage of predicted(FEF50％pred),forced expiratory flow at 75％of vital capacity as a percentage of predicted(FEF75％pred),and maxi-mal mid-expiratory flow as a percentage of predicted(MMEF％pred)compared to the non-asthma group(P＜0.001).Twenty-one predictive models incorporating EOS,total IgE,and small airway function indexes were constructed.All parameters demonstrated diagnostic efficacy for mild asthma(P＜0.001),with combined models outperforming individual parameters.The model incorporating EOS,total IgE,FEF50％pred,FEF75％pred and MMEF％pred exhibited the best diagnostic performance,The area under the curve[AUC(95％CI):0.888(0.855～0.920)],with a sensitivity of 86.29％and specificity of 77.32％.Conclusion The combination of small airway function indexes,EOS,and total IgE has diagnostic value for mild asthma.This approach is more simple,economical and safe than bronchial provocation test,making it suitable for initial screening in primary care hospitals.
籍彬彬;王燕;李馨利;张莹;杨晓娜;金思宇;于天威;谢华
110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科110016 沈阳,中国人民解放军北部战区总医院呼吸内科
轻度哮喘小气道嗜酸性粒细胞总免疫球蛋白E诊断
mild asthmasmall airwayeosinophilstotal immunoglobulin Ediagnostic
《中华临床免疫和变态反应杂志》 2026 (2)
83-90,8
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