呼气峰流速与COPD气流阻塞判定指标的相关性研究

Correlation study of PEF and prognosis index of airflow obstruction in patients with COPD

目的探讨呼气峰流速(PEF)对慢性阻塞性肺疾病(COPD)气流阻塞严重程度的评估与1 s用力呼气容积(FEV1.0)对COPD严重程度分级的相关性及临床意义。方法回顾性收集60例COPD患者及60例同期健康体检者肺功能中FVC、FEV1.0、FEV1.0及FVC与PEF等呼吸参数,分析PEF与FEV1.0的相关性、PEF筛查COPD气流阻塞的敏感性、特异性与准确度及以PEF诊断COPD气流阻塞的ROC曲线。结果 COPD组,FEV1.0与PEF的(r=0.815,P<0.05),其中,随气流阻塞程度加重,相关系数逐渐增大;吸烟组较不吸烟组的相关系数大。对照组60例,FEV1.0与PEF(r=0.306,P<0.05)。按气流阻塞严重程度分析PEF在筛查气流受限中的作用,PEF<70%Pred可筛查出81.67%经过肺功能检查证实的气流阻塞患者;PEF<60%Pred可筛查出100%重度-极重度气流受限。以PEF做COPD气流阻塞的诊断性试验,其ROC曲线下面积为0.912。结论 PEF与FEV1.0在COPD患者中有良好的相关性,COPD气流阻塞程度越重,其相关性越好;COPD组中,吸烟者的相关性较不吸烟者的相关性强;PEF作为筛选COPD气流阻塞的一个辅助指标,具有一定的临床可行性。

Objective To explore peak expiratory flow assessment of the severity of airflow obstruction and FEV1 as severity clas- sification of COPD and its correlation and clinical significance. Methods Retrospectively collected 60 patients with COPD and 60 healthy persons with the same period respiratory parameters,such as FVC, FEV1, FEV1/FVC and PEF,analyzed the correlation of FEV1 and PEF, PEF screening airflow obstruction of sensitivity, specificity,accuracy and the ROC curve of PEF diagnosis of the airflow obstruction in pa- tients with COPD. Results In COPD group, FEV1 and PEF correlation coefficient （r） was 0.815 （P = 0.000）. Correlation coefficient was gradually increasing with the degree of airflow obstruction worsened;correlation coefficient of smoking group was larger than the nonsmoking group. 60 cases of the control group,correlation coefficient （r） of FEV1 and PEF was 0. 306 （P = O. 017）. PEF analysis sensitivity,specificity and accuracy in screening airflow limitation,we obtained that PEF 〈70% pred could sift through 81.67% airflow obstruction confirmed by pulmonary function examination ;PEF 〈 60% pred could screen 100% severe to very severe airflow limitation. Using PEF as the degree of airflow obstruction of diagnostic test,the area under the ROC curve was 0.912. Conclusion PEF and FEV1 have strong cor- relation in COPD patients,the more serious the degree of airflow obstruction of COPD, the correlation is better;in COPD group,the correla- tion of smoking is stronger than that of nonsmoking;PEF used as an auxiliary index for screening airflow obstruction in COPD, has certain clinical feasibility.