脉冲振荡肺功能检测在慢性阻塞性肺疾病患者恶化风险评估中的应用

Application of impulse oscillometry lung function test in risk assessment of deterioration in COPD patients

目的探讨脉冲振荡肺功能检测(IOS)在慢性阻塞性肺疾病(COPD)恶化风险评估中的应用价值。方法选取184例COPD患者,用1年内发生COPD急性加重期(AECOPD)的次数评估COPD患者恶化风险,将COPD患者分为非频繁发作组(AECOPD发作≤1次/年)81例、频繁发作组(AECOPD≥2次/年)103例。患者稳定期均行常规肺功能测试(PFT)、IOS,PFT参数包括第1秒用力呼气末容积(FEV1)、用力肺活量(FVC)、FVC实际值与预计值比值(FVC%pred)、第1秒用力呼气末容积占其预计值的百分比(FEV1%pred)、用力呼出50%肺活量时的瞬时呼气流量(FEF50%)、用力呼出75%肺活量时的瞬时呼气流量(FEF75%)、呼气峰流速(PEF)、用力呼气时中段呼气流速(MMEF),根据FEV1%pred对气道阻塞严重程度进行分级(GOLD分级);IOS参数包括振荡频率为5 Hz时呼吸总阻抗(Z5)、振荡频率为5 Hz时电抗(X5)、振荡频率为5 Hz时电抗占其预计值的百分比(X5%pred)、振荡频率为5 Hz时气道总阻力(R5)、振荡频率为5 Hz时气道总阻力占其预计值的百分比(R5%pred)、振荡频率为20 Hz时的气道阻力(R20)、振荡频率为5和20 Hz时气道阻力差值(R5-R20)、ΔR5-R20[100×(R5-R20)/R20]、响应频率(Fres),用X5和R5对气道阻塞严重程度进行分级。用改良版英国医学研究委员会呼吸问卷(mMRC)评估患者的呼吸困难程度,用COPD评估测试(CAT)问卷评估患者的生活质量。用Pearson相关法分析各指标间的相关性。结果频繁发作组FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF等PFT参数均较非频繁发作组低(P均<0.05),非频繁发作组和频繁发作组GOLD分级差异有统计学意义(P<0.05)。频繁发作组Z5、X5、X5%pred、R5、R5%pred、R20、R5-R20、ΔR5-R20、Fres等IOS参数均较非频繁发作组高(P均<0.05),非频繁发作组和频繁发作组IOS分级差异有统计学意义(P<0.05)。频繁发作组mMRC、CAT评分均较非频繁发作组高(P均<0.05)。COPD患者Z5、X5%pred、R5、R5%pred、R20、R5-R20、ΔR5-R20、Fres与FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF、mMRC评分、CAT评分均呈负相关(P均<0.05),X5与FEV1、FVC、FVC%pred、FEV1/FVC、FEV1%pred、FEF50%、FEF75%、PEF、MMEF、mMRC评分、CAT评分均呈正相关(P均<0.05)。结论IOS可用于评价COPD患者的恶化风险。

Objective To explore the application value of impulse oscillometry lung function test(IOS)in the risk as⁃sessment of deterioration in chronic obstructive pulmonary disease(COPD).Methods A total of 184 patients with COPD were selected,and the frequency of acute exacerbation of COPD(AECOPD)within 1 year was used to evaluate the risk of deterioration in COPD patients;COPD patients were divided into the non-frequent attack group(AECOPD attack≤1 time/year,81 cases)and frequent attack group(AECOPD attack≥2 times/year,103 cases).Routine pulmonary function test(PFT)was performed in all patients at stable stage.PFT parameters were measured,including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),the ratio of the actual value of FVC to the predicted value(FVC%pred),the percentage of forced expiratory volume in the first second to its predicted value(FEV1%pred),instantaneous expiratory flow at 50%of forced expiratory vital capacity(FEF50%),instantaneous expiratory flow at 75%of forced expira⁃tory vital capacity(FEF75%),peak expiratory flow(PEF),and mid-expiratory flow during forced expiratory flow(MMEF).The severity of airway obstruction was graded according to FEV1%pred(GOLD classification);the IOS parame⁃ters were detected,including the total respiratory impedance at the oscillation frequency of 5 Hz(Z5),the reactance at the oscillation frequency of 5 Hz(X5),the percentage of the reactance to its predicted value at the oscillation frequency of 5 Hz(X5%pred),the total airway resistance at the oscillation frequency of 5 Hz(R5),the percentage of the total airway resis⁃tance to its predicted value at the oscillation frequency of 5 Hz(R5%pred),the airway resistance at the oscillation frequency of 20 Hz(R20),the airway resistance difference at the oscillation frequency of 5 and 20 Hz(R5-R20),ΔR5-R20[100×(R5-R20)/R20],and response frequency Fres;X5 and R5 were used to classify the severity of airway obstruction.The modified British Medical Research Council Respiratory Questionnaire(mMRC)was used to evaluate the degree of dyspnea,and the COPD Assessment Test(CAT)questionnaire was used to evaluate the quality of life of patients.Pearson correla⁃tion method was used to analyze the correlation between each index.Results The PFT parameters such as FEV1,FVC,FVC%pred,FEV1/FVC,FEV1%pred,FEF50%,FEF75%,PEF and MMEF in the frequent attack group were lower than those in the non-frequent attack group(all P<0.05).There was a statistically significant difference in GOLD classification between the non-frequent attack group and the frequent attack group(P<0.05).The IOS parameters such as Z5,X5,X5%pred,R5,R5%pred,R20,R5-R20,ΔR5-R20 and Fres in the frequent attack group were higher than those in the non-frequent attack group(all P<0.05).There was a statistically significant difference in IOS grading between the non-fre⁃quent attack group and the frequent attack group(P<0.05).The scores of mMRC and CAT in the frequent attack group were higher than those in the non-frequent attack group(both P<0.05).Z5,X5%pred,R5,R5%pred,R20,R5-R20,ΔR5-R20,Fres were negatively correlated with FEV1,FVC,FVC%pred,FEV1/FVC,FEV1%pred,FEF50%,FEF75%,PEF,MMEF,mMRC score,and CAT score in COPD patients(all P<0.05).X5 was positively correlated with FEV1,FVC,FVC%pred,FEV1/FVC,FEV1%pred,FEF50%,FEF75%,PEF,MMEF,mMRC score and CAT score(all P<0.05).Conclusion IOS can be used to evaluate the risk of deterioration in patients with COPD.