目的:比较各种诊断性支气管激发试验(BPT)在运动员下气道功能障碍(LAD)评估中的表现,并提供最佳临床实践。
方法:系统评价与敏感性和特异性荟萃分析。
方法:PubMed,EBSCOhost和WebofScience(1990年1月1日-2021年12月31日)。
方法:原始全文研究,包括通过基于症状的问卷/病史和/或直接和/或间接BPT进行LAD评估的运动员/体力活动者(15-65岁)。
结果:在26项包含BPT诊断性能定量荟萃分析数据的研究中(n=2624名参与者;33%为女性);22%的医生诊断为哮喘,51%的患者报告了LAD症状。在有LAD症状的运动员中,eucapnic自愿性呼吸过度(EVH)和运动挑战测试(ECTs)以46%的灵敏度和74%的特异性证实了诊断,51%的灵敏度和84%的特异性,分别,而乙酰甲胆碱BPT的敏感性为55%,特异性为56%。如果EVH是参考标准,LAD症状的存在对EVH阳性的敏感性为78%,特异性为45%,而ECT的敏感性为42%,特异性为82%。如果ECT是参考标准,LAD症状的存在对阳性ECT有80%的敏感性和56%的特异性,而EVH对阳性ECT表现出65%的敏感性和65%的特异性。
结论:在运动员的LAD评估中,EVH和基于现场的ECT提供相似和中等的诊断测试性能。相比之下,乙酰甲胆碱BPT具有较低的整体测试性能。
未经评估:CRD42020170915。
OBJECTIVE: To compare the performance of various diagnostic bronchoprovocation tests (BPT) in the assessment of lower airway dysfunction (LAD) in athletes and inform best clinical practice.
METHODS: Systematic review with sensitivity and specificity meta-analyses.
METHODS: PubMed, EBSCOhost and Web of Science (1 January 1990-31 December 2021).
METHODS: Original full-text studies, including athletes/physically active individuals (15-65 years) who underwent assessment for LAD by symptom-based questionnaires/history and/or direct and/or indirect BPTs.
RESULTS: In 26 studies containing data for quantitative meta-analyses on BPT diagnostic performance (n=2624 participants; 33% female); 22% had physician diagnosed asthma and 51% reported LAD symptoms. In athletes with symptoms of LAD, eucapnic voluntary hyperpnoea (EVH) and exercise challenge tests (ECTs) confirmed the diagnosis with a 46% sensitivity and 74% specificity, and 51% sensitivity and 84% specificity, respectively, while methacholine BPTs were 55% sensitive and 56% specific. If EVH was the reference standard, the presence of LAD symptoms was 78% sensitive and 45% specific for a positive EVH, while ECTs were 42% sensitive and 82% specific. If ECTs were the reference standard, the presence of LAD symptoms was 80% sensitive and 56% specific for a positive ECT, while EVH demonstrated 65% sensitivity and 65% specificity for a positive ECT.
CONCLUSIONS: In the assessment of LAD in athletes, EVH and field-based ECTs offer similar and moderate diagnostic test performance. In contrast, methacholine BPTs have lower overall test performance.
UNASSIGNED: CRD42020170915.