从高危人群中筛查诊断慢性阻塞性肺疾病的效果评估

Evaluation of chronic obstructive pulmonary disease screening in a high risk population

目的探讨从高危人群中筛查COPD患者的效率。对单独或联合筛查方法诊断COPD的敏感度、特异度和可靠性进行评估。方法2003年1-7月对241例自愿接受检查者进行筛查，筛查对象均为40岁以上且必须符合以下标准之一：慢性咳嗽和咳痰、活动后气短和长期大量吸烟史（吸烟量〉10包年）。由固定的呼吸科医生询问病史，进行体格检查，拍摄X线胸片，测定肺通气功能，进行支气管舒张试验。多组均数之间的比较采用方差分析，组间两两比较采用t检验。从灵敏度、特异度等方面评价临床表现、单独和联合危险因素指标诊断COPD的价值。结果在241例COPD高危人群中，肺功能检查符合COPD者156例（64．7％），其中126例为首次诊断病例，占全部筛查者的52．3％；轻、中度COPD患者87例（36．1％），重度和极重度COPD患者69例（28．6％）。在单因素筛查中，以活动后气短筛查COPD的灵敏度为61．5％，特异度为61．2％。40岁以上且有重度吸烟、慢性咳嗽和咳痰及活动后气短3项之一者，筛查诊断的灵敏度均达到90％以上。结论对高危人群进行肺功能筛查是方便、快捷的筛查方法，可以提高COPD的早期诊断水平。以临床表现和危险因素联合筛查可以提高COPD诊断的灵敏度和特异度。临床上可以根据筛查的不同目的选用适宜的联合筛查方法。

Objective To investigate the results of spirometry testing used in the screening of COPD from at risk populations. Methods A survey of the population aged over dO years with any of chronic cough and sputum, dyspnea, heavy tobacco smoke was performed, using a questionnaire on clinical characteristics of COPD. Spirometry and chest X ray examination were performed. Different screening methods were compared for sensitivity and specificity for COPD diagnosis. Results Of 241 surveyed persons, 156 were diagnosed as having COPD, among whom 126 cases were firstly diagnosed. Among all surveyed persons, 87 （36. 1% ） cases had mild and moderate COPD, while 69 （28. 6% ） had severe and very severe disease. The sensitivity and specificity for diagnosis of COPD of shortness of breath were 61.5% and 61.2% respectively. Combination of respiratory symptoms and risk factors improved the screening power. More than 40 years of age combined with any of heavy smoking, chronic cough and sputum, or shortness of breath, improved the sensitivity to more than 90 percent. Conclusions Spirometry test screening of the at risk population can effectively improve early diagnosis of COPD.