呼气负压技术检测慢性阻塞性肺疾病患者呼气气流受限的可重复性分析

Reproducibility of the negative expiratory pressure technique in detecting expiratory flow limitation on chronic obstructive pulmonary disease patients

目的 分析呼气负压（NEP）技术检测慢性阻塞性肺疾病（COPD）患者呼气气流受限（EFL）的可重复性.方法 不同时间分别2次采用NEP技术检测72例COPD患者EFL.采用Kappa检验分析前后2次检测3分法EFL评分、5分法EFL评分诊断EFL的一致性,采用配对t检验分析前后2次检测气流受限（FL）指数评价EFL的可重复性.结果 第1次测试时,72例COPD患者中54例（75%）出现EFL,18例无EFL,18例仅卧位出现EFL,36例坐位和卧位均检测到EFL.应用3分法评分,第1次测试和第2次测试有58例检测结果前后一致,Kappa系数为0.69（P＜0.001）.应用5分法评分,第1次测试和第2次测试有52例检测结果前后一致,Kappa系数为0.65（P＜0.001）.第1次和第2次测试FL指数在坐位（P＜0.05）和卧位（P＜0.05）的差异均有统计学意义.结论 应用NEP技术检测COPD患者EFL,3分法和5分法EFL评分的重复性较好,FL指数的重复性较差.在NEP技术临床推广应用前,还需进一步探讨其特性.

Objective To evaluate the reproducibility of Negative Expiratory Pressure（NEP）technique in detecting expiratory flow limitation （EFL） on chronic obstructive pulmonary disease （COPD） patients. Methods EFL was evaluated with NEP technique in 72 subjects having stable COPD on two occasions. Agreement between testing occasions was assessed with the κ statistic for the 3-point and 5-point EFL scores, and with paired t-test for FL index. Results On the first testing occasion, 18 subjects had no EFL, 18 subjects had EFL in the supine position, and 36 subjects in the sitting and the supine position. Using the 3-point score, agreement was present in 58 of the 72 subjects at time 2 （κ =0.69, P〈0.001 ）, indicating a substantial agreement was found. Using the 5-point score, agreement was seen in 52 of the 72 subjects （κ =0.65, P〈0.001 ）, also indicating a substantial agreement. The difference of FL index between the first and the second occasion was significant in both the sitting （P〈0.05） and supine （P〈0.05） positions. Conclusion Both 3-point and 5-point scores provided a reproducible assessment of EFL on COPD patients but the FL index seemed less reproducible. More research were needed before NEP technique was promoted to be used clinically.