肺通气功能非特异性表现的分布及特点初探

A preliminary study of the distribution and the characteristics of nonspecific pulmonary function

目的 了解通气功能非特异性表现在肺功能检查结果中所占的比例,探讨患者肺功能、临床、影像特点及其临床意义.方法 统计2003年1月1日至2012年12月31日北京医院同一台肺功能机中全套肺功能检查的数据,明确肺通气功能非特异性表现[指FEV1/FVC和TLC正常,但FEV1和（或）FVC降低的肺功能]比例.选取2012年1月1日至6月30日临床和影像资料完整的病例资料,分别以正常组、阻塞组、限制组、混合组作为对照,分析肺通气功能非特异性表现患者的肺功能、临床和影像特点.结果 10年间同一台肺功能机共完成全套肺功能检查14 771例,其中肺通气功能非特异性表现2 759例（18.68％）,FEV1、FVC均降低组比例最高.2012年前半年资料完整的病例共341例,男女比例为1.37∶1,平均年龄（66±12）岁.非特异组小气道指标异常、RV/TLC异常升高的比例高于正常组,多因素分析提示TLC占预计值％（OR=0.668,P＜0.01,95％ CI为0.563～0.791）、FEF25-75占预计值％（OR =0.963,P＜0.01,95％ CI为0.939 ～0.988）、RV占预计值％（OR=1.144,P＜0.01,95％CI为1.075 ～1.217）、RV/TLC（OR=1.31,P ＜0.01,95％ CI为1.150～1.492）差异有统计学意义.非特异组小气道指标异常比例低于阻塞组,多因素分析提示性别（OR=15.283,P ＜0.01,95％ CI为3.526～66.248）、TLC占预计值％（OR=0.961,P=0.02,95％ CI为0.928 ～0.994）、FEF50占预计值％（OR=1.189,P＜0.01,95％ CI为1.103～1.281）差异有统计学意义.非特异组有呼吸道症状的患者比例高于正常组,确诊气道疾病比例介于正常组与阻塞组之间,疾病及影像表现无特异性.结论 肺通气功能非特异性表现检出率高,肺功能以小气道功能障碍为主,同时存在限制因素.临床、影像学特异性不高,对临床诊断没有明确指向性.

Objective To investigate the manifestations,pulmonary function test （PFT） characteristics and imaging features of patients with nonspecific pulmonary function （NSPF）.Methods All the data from the same PFT apparatus in Beijing Hospital were collected from January 2003 to December 2012.NSPF was defined as normal FEV1/FVC and TLC,but decreased FEV1 or FVC or both.Patients with complete clinical data from January 2012 to June 2012 were enrolled into this analysis.The NSPF group was compared with the normal group,the obstructive group,the restrictive group and the mixed group.Results There were totally 14 771 cases of PFT on this apparatus during 10 year period,and those with NSPF were 2759 （18.68%）.From January 2012 to June 2012,341 patients were enrolled into this study with a sex ratio of 1.37∶ 1,and an average age of 66 ± 12 years.Compared with the normal group,the NSPF group had a significantly higher rate of small airway abnormalities and elevated RV/TLC.Multiple logistic regression analysis showed that statistical differences were found in TLC% pred （OR =0.668,P 〈 0.01,95% C1 0.563-0.791）,FEF25-75 % pred （OR =0.963,P 〈 0.01,95 % CI 0.939-0.988）,RV% pred （OR =1.144,P 〈 0.01,95% CI 1.075-1.217）,and RV/TLC （OR =1.31,P 〈 0.01,95% CI 1.15-1.492）.Compared with the obstructive group,the NSPF group had a significantly lower rate of small airway abnormalities.Multiple logistic regression analysis showed that female gender（OR =15.283,P 〈 0.001,95% CI 3.526-66.248）,TLC% pred （OR =0.961,P =0.02,95% CI 0.928-0.994）,and FEF50% % pred （OR =1.189,P 〈0.001,95% CI 1.103-1.281） were significantly different between the 2 groups.Respiratory symptoms were more common in the NSPF group.Airway diseases were diagnosed in more cases of the NSPF group when compared to the normal group,but in fewer cases when compared to the obstructive group.Clinical manifestations and imaging features of the NSPF cases were not specific.Conclusions NSPF is a common clinical condition which mainly affects the small airway function with some degree of restrictive dysfunction.NSPF has limited predictive value for diagnosis because the manifestations and imaging features are not specific.