慢性阻塞性肺疾病患者脉冲振荡肺功能测定及其意义

Measurement and significance of impulse oscillometry in patients with chronic obstructive pulmonary disease

目的探讨脉冲振荡肺功能（IOS）测定在慢性阻塞性肺疾病（COPD）中的应用价值。方法测定37例COPD患者的IOS主要参数,与37例健康人作比较,并与常规肺功能指标作直线相关分析,同时评价各IOS主要参数在COPD诊断中的价值。结果与健康组比较,COPD组呼吸总阻抗（Zrs）、5 Hz与20 Hz时黏性阻力及其差值（R5、R20、R5-R20）、共振频率（Fres）及中心和周边阻力（Rc、Rp）均明显增高,5 Hz时电抗（X5）明显下降（均P〈0.01）;在COPD组,Fres、Rp、R5-R20、CL、Zrs与1秒钟用力呼气容积占预计值百分比（FEV1占预计值%）呈显著负相关,Fres、CL与1秒钟用力呼气容积/用力肺活量（FEV1/FVC）也呈明显负相关,而X5与FEV1占预计值%呈显著正相关（P〈0.05~0.001）。Fres、R5-R20、X5诊断COPD具有较高的敏感度（分别为94.6%、91.9%、54.1%）和特异度（75.7%、67.6%、100%）。结论IOS测定能较好地反映COPD气道阻力的变化,可用于COPD的病情评价。

Objective To explore the clinical application value of impulse oscillometry（IOS） in the patients with chronic obstructive pulmonary disease（COPD）. Methods The IOS parameters of 37 cases of COPD were measured and compared with those of 37 normal cases. Linear correlation analysis was done between the IOS parameters and the conventional pulmonary function indexes such as FEV~ ~ and FEV1/FVC, and the diagnostic value of the IOS parameters in COPD was discussed. Results Compared with those of the normal group,respiratory impedance（Zrs）, resistance at 5 Hz and 20 Hz （R5, R20 ） and their difference（R5- R20 ）, resonance frequency（Fres）, central resistance （Rc） and peripheral resistance（Rp） in the COPD group increased significantly,while reactance at 5 Hz（X5 ） decreased obviously （ P 〈 0.01 ）. In the COPD group, Fres, Rp, R5- R20, lung compliance （CL） and Zrs were all correlated negatively with FEV1%, and Fres and CL were correlated negatively with FEV1/FVC, but X5 was correlated positively with FEV1%（ P 〈0.05-0. 001）. The sensitivities of Fres,R5-R20 and X5 diagnosing COPD were 94.6% ,91.9% and 54.1% respectively,and the specificities were 75.7% ,67.6% and 100%. Conclusion IOS can reflect the variation of airway resistance in COPD,and thus can be used to evaluate the severity of COPD.