Diagnostic Value of Oral Prednisolone Test for Chronic Obstructive Pulmonary Disorders
Diagnostic Value of Oral Prednisolone Test for Chronic Obstructive Pulmonary Disorders
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DOI：
10.1370/afm.1223
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发表时间：
2011-03-01
影响因子：
4.4
通讯作者：
Hoes, Arno W.
中科院分区：
文献类型：
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作者：
Broekhuizen, Berna D. L.;Sachs, Alfred P. E.;Hoes, Arno W.
目的：我们想确定慢性阻塞性肺疾病的口服泼尼松龙试验的诊断价值方法233例咳嗽超过14天，没有已知的慢性阻塞性肺疾病（COPD）或哮喘，在2006年和2009年之间，在荷兰的初级保健诊断研究参加。这些患者使用30 mg/d的泼尼松龙试验14天，并记录使用支气管扩张剂前后1秒用力呼气量（FEV（1））的测量结果。专家小组根据广泛的诊断检查确定是否存在COPD和哮喘。泼尼松龙试验应答者的比例比较每个诊断组的FEV 1增加超过200 mL或基线值的12%，并通过logistic回归和受试者工作特征曲线下面积分析量化试验的诊断价值结果在COPD患者中，23%的患者（14/61）对测试有反应;在哮喘患者中，4%（1/25）有反应;在哮喘和COPD患者中，7%（1/14）有反应;在没有哮喘或COPD的患者中，11%（133人中的14人）有反应。出乎意料的是，作为应答者与COPD相关（OR = 2.4; 95%置信区间[CI]，1.1-5.2）。经多因素分析，调整年龄，性别和吸烟，OR = 2.0（95% CI，0.8-5.0），ROC面积未增加（0.78; 95% CI，0.72-0.85 vs 0.79;结论对泼尼松龙试验的反应提示COPD，但对更容易获得的特征没有增加诊断价值。
PURPOSE We wanted to determine the diagnostic value of an oral prednisolone test for chronic obstructive pulmonary disorders.METHODS Two hundred thirty-three patients with cough for longer than 14 days, without known chronic obstructive pulmonary disease (COPD) or asthma, participated in a diagnostic study in Dutch primary care between 2006 and 2009. These patients used a 14-day prednisolone test of 30 mg/d and recorded before-after bronchodilator measurements of forced expiratory volume in 1 second (FEV(1)). An expert panel determined the presence or absence of COPD and asthma based on an extensive diagnostic workup. The proportion of responders to the prednisolone test (increased FEV(1) exceeding 200 mL or 12% of baseline) per diagnosis group was compared, and the diagnostic value of the test was quantified by logistic regression and analysis of the area under the receiver operating characteristic curve (ROC area).RESULTS In patents with COPD, 23% (14 of 61) responded to the test; in patients with asthma 4% (1 of 25) responded; in patients with asthma and COPD, 7% (1 of 14) responded; and in those without asthma or COPD, 11% (14 of 133) responded. Being a responder was, unexpectedly, associated with COPD (OR = 2.4; 95% confidence interval [CI], 1.1-5.2). After multivariate analysis, adjusting for age, sex, and smoking, the OR = 2.0 (95% CI, 0.8-5.0) and the ROC area did not increase (0.78; 95% CI, 0.72-0.85 vs 0.79; 95% CI, 0.72-0.85).CONCLUSION A response to a prednisolone test was suggestive of COPD, but added no diagnostic value to more easily obtainable characteristics.