上海市成人肺功能医学参考值范围的初步研究

Preliminary Study on Medical Reference Range for Adult Pulmonary Function Parameters in Shanghai

目的初步建立上海地区成人肺功能医学参考值范围和一秒率实测值占预计值百分比的正常值。方法选取2009年6月至2010年2月的健康成年体检者,对合格人群进行肺功能测定,根据华东地区肺功能正常预计值公式判断结果,以肺功能正常和基本正常2∶1的比例入选360例受试者,按年龄分为6组,每组60例,男女各半。收集14项肺功能参数:肺活量(VC)、功能残气量(FRC)、肺总量(TLC)、残气容积(RV)、残气容积/肺总量(RV/TLC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、一秒率(FEV1/FVC)、呼气峰流量(PEF)、用力呼出25%肺活量时呼气流量(FEF25%)、用力呼出50%肺活量时呼气流量(FEF50%)、用力呼出75%肺活量时呼气流量(FEF75%)、一氧化碳弥散量(DLCO)、每升肺泡容积的一氧化碳弥散量(KCO)。以性别、年龄、身高、体重为自变量建立新的预计值公式,并根据新公式推算各参数的医学参考值范围,计算一秒率实测值占预计值的正常百分比。结果建立了新的肺功能正常预计值公式,其中DLCO=5.206+4.314×性别("男"=1,"女"=0)-0.144×年龄(y)+0.098×身高(cm)+0.082×体重(kg),KCO=9.346-0.026×年龄(y)-0.031×身高(cm)+0.025×体重(kg)。推算出VC、FVC、FEV1、FEV1/FVC的正常值低限(LLN)(P5),FRC、TLC、RV、RV/TLC的LLN(P2.5)及正常值高限(P97.5),其中FEV1/FVC LLN(P5)=101.924-0.144×年龄(y)-0.118×身高(cm),其实测值占预计值百分比的正常值低限为92%。结论在国内无肺功能参数医学参考值和一秒率判断标准,而目前华东地区弥散量预计值偏高的情况下,可以参考本项研究结果。FEV1/FVC的LLN或其实测值占预计值百分比的92%可作为阻塞性通气障碍的诊断标准。FEV1<LLN可代替其实测值占预计值的80%作为轻度通气功能障碍的标准。

Objective To establish a medical refere nce for adult pulmonar y function parameters and a normal FEV1/FVC%pred in population of Shanghai.Methods Subjects who underwent routine physical examination were initially screened and those who met enrollment criteria with age over 18 years old were required t o underwent pulmonary function tests in Zhongshan Hospital from June 2009 to Fe bruary 2010.After screening of 450 subjects,a total of 240 subjects with norma l pulmonary function and 120 subjects with mild small airway abnormalities were enrolled in this study according to the prediction equations established in 1988.All subjects were assigned into 6 groups according to their age with 30 males a md 30 females in each group.Pulmonary function parameters including VC,FVC,F EV1,FEV1/FVC,PEF,FEF25%,FEF50%,FEF75%,RV,FRC,TLC, RV/TLC,DLCO,and KCO were collected for analysis.New prediction equations for the above 14 parameters were established by parameters of anthropometry.The medical reference ranges of 14 parameters were calculated according to the new prediction equations.The nor mal FEV1/FVC%pred was also calculated.Results New prediction equations for norm al adult pulmonary function parameters in Shanghai were established.DLCO=5.20 6＋4.314×gender（＂male＂=1,＂female＂=0）-0.144×age（y）＋0.098×height（ cm）＋0.082×weight（kg）,KCO=9.346-0.026×age（y）-0.031×height（cm）＋0.025×weight（kg）. The LLN（P5） of VC,FVC,FEV1,FEV1/FVC,the LLN（P2.5） and the upper lim it of normal value（P97.5） of FRC,TLC,RV,RV/TLC were calculated.The LLN（P 5） of FEV1/FVC=101.924-0.144×age（y）-0.118×high（cm）.The lower normal limit of FEV1/FVC%pred was 92%.Conclusions This is the first tim e to have the medic al reference of FEV1/FVC%pred in China,and new prediction equations for DLC O in Shanghai.The LLN of FEV1/FVC or FEV1/FVC%pred92% can be used as diagnosti c cri teria for obstructive ventilation disorder.Instead of using FEV1%pred80%,FE V1LLN can be used as diagnostic criteria for mild ventilation disorder.