Positive "alveolar" responses to antigen inhalation provocation tests: their validity and recognition.
Positive "alveolar" responses to antigen inhalation provocation tests: their validity and recognition.
复制标题
对抗原吸入激发试验的阳性“肺泡”反应：其有效性和识别性。
作者：
D. Hendrick;R. Marshall;J. Faux;J. Krall
通过对31例外源性过敏性肺泡炎患者的144项抗原和对照试验结果，评价吸入试验在外源性变态反应性肺泡炎调查中的有效性。观察到肯定的迟发反应模式。研究对象的肺部对雾化的鸟类血清和粪便的反应，与在鸟舍或阁楼中“自然”暴露后的反应相同，对农民肺和蘑菇工人肺的“职业”挑战后的反应也是相同的。一般来说，阳性测试很容易从与流感样疾病和锻炼引起的过度呼吸困难相适应的症状和体征中识别出来。它们与6项现成的客观监测指标的显著变化有关--运动分钟通气量(大于或等于+15%)、体温(>；37.2摄氏度)、循环中性粒细胞(大于或等于+2500/mm3)、运动呼吸频率(大于或等于+25%)、循环淋巴细胞(大于或等于淋巴细胞减少的-500/mm3)和用力肺活量(大于或等于-15%)。这些验证性监测试验的特异度约为95%，敏感度为85-48%。弥散能力、肺容量细分或静息分钟通气量/呼吸频率的测量被证明太不敏感而没有用，听诊和胸部X线片也是如此。我们的结论是，在这些不那么敏感的测试中引发重大变化的反应是不必要的令人痛苦的，也可能是不必要的危险。
The validity of inhalation tests in the investigation of extrinsic allergic alveolitis was assessed from the results of 144 antigen and control tests in 31 subjects. A definitive pattern of positive late responses was observed. Reactions to nebulised bird serum and droppings in subjects with bird fancier's lung were identical to reactions after "natural" exposures in aviaries or lofts, and to reactions after "occupational" challenges in subjects with farmer's lung and mushroom worker's lung. In general, positive tests were easily recognised subjectively from symptoms and signs appropriate to an influenza-like illness and undue respiratory effort on exercise. They were associated with significant changes in six readily available objective monitoring measurements--exercise minute ventilation (greater than or equal to +15%), body temperature (> 37.2 degrees C), circulating neutrophils (greater than or equal to +2500/mm3), exercise respiratory frequency (greater than or equal to +25%), circulating lymphocytes (greater than ore equal to -500/mm3 with lymphopenia), and forced vital capacity (greater than or equal to -15%). These confirmatory monitoring tests had specificities of approximately 95% and sensitivities of 85-48%. Measurement of diffusing capacity, lung volume subdivisions, or resting minute ventilation/respiratory frequency proved to be too insensitive to be useful, as did auscultation and chest radiography. We conclude that responses that do provoke significant changes in these less sensitive tests are unnecessarily distressing and, presumable, unnecessarily hazardous.