慢性阻塞性肺疾病患者病情变化的肺功能评价

Assessment of Lung Function during Changes of Chronic Obstructive Pulmonary Disease

目的探讨肺功能检测在慢性阻塞性疾病患者诊断和病情变化中的价值。方法资料回顾性分析,分析我院2004年5月～2006年5月临床诊断为慢性阻塞性肺疾病患者208例,依FEV1/FVC<70%,同时FEV1%pre<80%为标准,比较吸入支气管扩张剂前及20min后,两者判断的一致性。以及根据吸入支气管扩张剂前后肺功能指标变化对COPD病情分级的影响。结果吸入支气管扩张剂前及吸入20min后,两次同时符合标准者140例;前后均不符合有20例(占9·6%);吸入支气管扩张剂前符合,但吸入后不符合26例(占12·5%);吸入前不符合,而吸入后符合者16例(占7·7%);吸入前不符合,而吸入后FEV1/FVC<70%,但FEV1%pre>80%6例(占2·9%)。最后诊断COPD有156例。吸入支气管扩张剂前后判断一致性较差。吸入前后肺功能的变化对COPD的病情分级判断一致性也较差。在156例COPD中,支气管扩张试验阳性20例(占12·3%)。结论严格执行COPD防治指南,规范COPD诊治中的肺功能检测,对COPD的防治有着极其重要的作用。

Objective To investigate the value of lung function examination on the diagnosis and the grading of severity in patients with chronic obstructive pulmonary disease （COPD）, Methods Retrospective analysis was used for patients with COPD diagnosed clinically from May 2004 to May 2006. FEV1/FVC 〈 70% in combination with an FEV1 〈 80% of the predicted value was taken as the standard to compare the agreement between the two diagnoses before and 20 min after inhalation of bronchodilator. And the influence of changes of lung function indexes before and after inhalation of bronchodilator on the grading of severity in patients, Results The average age of 208 patients enrolled （ 150 females and 58 males） was （66 ± 13） years, taking FEV1/FVC 〈 70% in combination with an FEV1 〈 80% of the predicted value as the standard, before inhalation of bronchodilator and 20 min after inhalation, there were 140 cases who are at the same time agreed ; 20 cases who are not agreed at all （ accounting for 9. 6 % ） ; 26 cases who are agreed before inhalation and not agreed after inhalation （ accounting for 12. 5 % ） ; 16 cases who are not agreed before inhalation and agreed after inhalation （ accounting for 7. 7 % ） ; 6 cases who are not agreed before inhalation, and FEV1/FVC 〈70%, but FEV1 〉 80% of the predicted value （accounting for 2. 9 % ）. Finally 156 patients were diagnosed as having COPD. The consistency was worse before and after inhalation of bronchodilator, the, Kappa value was O. 309.. As comparing the influence of the change of lung function after inhalation on the grading of severity in patients with COPD, the results showed Kappa was O. 392, which indicates the consistency of diagnosis is worse. Among the 156 COPD patients, there were 20 cases whose bronchodilator test was positive （accounting for 12. 3% ）. Conclusion It is important to carry out strictly The Global Initiative for Chronic Obstructive Lung Disease, standardize measurement of lung function in diagnosis and assessment of COPD. This is of very important role in prevention and treatment of COPD.