집먼지 진드기(Dermatophagoides farinae) 흡입 유발 검사에서 기관지 반응 예측에 영향을 끼치는 인자에 대한 연구

Abstract

The most importan method in detecting the causative allergens in bronchial asthma is bronchoprovocation test. However, problems in implementation and patients discomfort make us wonder if general parameters alone could predict the results of specific bronchial provocation test. In this study we compared the results of Dermatophagoides farinae-bronchial provo- cation test with skin prick test, RAST, serum total IgE level, total eosinophil count (TEC), PC20 of methacholine, age, sex and duration of disease in 177 asthma patients for evaluation of predictive values. The results were followed.: (1) Early response(GE I) with inhalation of 1:10000 w/v solution of whole body extract of D.farinae was in 12.4%, isolated late re- sponse(GL) in 7.9%, dual response(GD) in 12.4% and 1:2500 response(GR) within 10 minutes on inhalation of 1:2500 w/v solution of whole body extract of D. farinae followed 7 hours after challenge with 1:10000 w/v solution was in 11.2% 1:1000 response(GE io) within 10 minutes on inhalation of 1:1000 w /v solution was in 45% of 177 cases. (2) The mean age in the dual response and 1:2500 response group were lower than that of other groups. The mean age of the positive and negative response groups were 29. 28+-10.9 years and 33.25+-9.8 years respectively. The average of negative response rate was 45.8% in each age groups. The negative response rates was 12.5% in the second decade and 25% in the six decade, which was significantly lower than that of the other age group. (3) The positive rate of skin prick test of D. farinae(A/H ratiol) did not differ sig- nificantly among the response groups, but were in the following descending order 1:2500 response(G R), dual response(GD), early re- sponse(GE I), 1:1000 response(GE p), isolated late response(GL >) and negative response group(GN io). The mean A/H ratio of D.far- inae skin prick test was higher in the chal- lenge positive group than of challenge nega- tive group. (4) The PC20M of the challenge positive and negative response group were 0.365 mg /ml and 0.631 mg/ml, indicating that the nonspecific bronchial reactivity appeared to be at lower level in the challenge positive group. The PC20M did not show any signifi- cant difference among the response groups but it did appear the lowest PC2QM in the dual response group. (5) The serum IgE levels of the challenge negative and positive groups were 224.39 IU/ml and 491.473 IU/ml respectively, The serum IgE level was the highest in the dual response group but there was no significant difference among others response groups. (6) The total eosinophil count(TEC) of the challenge positive group was 504+354/mm', which was significantly higher than that of the challenge negative group(366+299/mm). TEC was highest in the dual response group with significant difference among the other response groups. (7) The negative response rate of challenge test was 62% in patients with duration of less than 1 year and 34% in patients with longer disease duration. The negative response rate to the bronchoprovocation test was statistically signficantly lower in patients with longer duration of disease. (8) The positive predictive value for discriminant analysis between the challenge positive and negative groups was 75.14% with A/H ratio, age, PC20M, serum total IgE, and duration of disease in contributing order. The positive predictive value for discriminant analysis among the challenge response groups was 38.65% with A/H ratio, serum total IgE, duration of disease and age in contributing order.