全球肺功能倡议预计值对济南市老年人的适用性检验

Applicability of Global Lung Function Initiative 2012 reference equations for spirometry to elderly Chinese in Jinan City

目的检验全球肺功能倡议(GLI)-2012版肺通气功能预计值对济南市老年人的适用性。方法招募无吸烟史、60~84周岁的健康老年人,进行肺通气功能检查,记录用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、FEV1/FVC、最大呼气中期流量(MMEF)。以GLI-2012版预计值为依据,计算各参数Z分数。配对t检验分别比较GLI-2012版均值的预计值与实测值、GLI-2012版正常值下限(LLN)预计值与华东地区即中山-2011版LLN。结果研究纳入438例受试者,男210例,女228例。FVC、FEV1、FEV1/FVC和MMEF在男性中的Z分数分别为0.23±1.34、0.27±1.31、0.03±0.71、-0.03±0.94,在女性中的Z分数分别为0.22±0.95、0.08±0.89、-0.28±0.65、-0.14±0.90。GLI-2012版均值预计值与实测值吻合良好,但对FEV1/FVC的LLN预计值显著低于中山-2011版,男性LLN均差的95%CI为(-5.79^-5.55)%(t=-91.310,P<0.001)。以GLI-2012版LLN为标准时,阻塞的检出率与珋x-3s标准相近(0.9%vs 0.7%)。结论尽管GLI-2012版对肺通气功能参数均值的预计值适用于济南市老年人,但对LLN的预计值偏低,易致老年人阻塞性肺通气功能障碍诊断不足。

Objective To validate the applicability of Global Lung Function Initiative（ GLI）-2012 reference values for spirometry to elderly Chinese in Jinan City. Methods Healthy people aged 60-84 without smoking history were recruited and underwent spirometry. FVC（ forced vital capacity）,FEV1（ forced expiratory volume in one second）,FEV1/FVC,and MMEF（ maximal midexpiratory flow） were recorded. Z-scores were computed according to the GLI-2012 reference values. Comparisons of GLI-2012 predicted values and observed values,and lower limit of normal（ LLN）computed using GLI-2012 and Zhongshan-2011 equations were performed by paired t test. Results A total of 438 subjects（ 228 females,210 males） were completely qualified. The Z-scores of FVC,FEV1,FEV1/FVC and MMEF for males were 0.23±1.34,0.27±1.31,0.03±0.71,-0.03±0.94,and for females were 0.22±0.95,0.08±0.89,-0.28±0.65,-0.14±0.90. The predicted mean values of GLI-2012 were in good agreement with observed values. However,the LLN of FEV1/FVC predicted by GLI-2012 equations was lower than that by Zhongshan-2011. The 95%CI of mean difference for males was（-5.79—-5.55） %（ t =-91.310,P〈0.001）. The proportion of abnormal FEV1/FVC in the sample was 0.9% in terms of the GLI-2012 LLN,which was similar to the proportion when using 珋x-3 s as the cut offvalue（ 0.7%）. Conclusion The GLI-2012 predicted mean values for spirometry are appropriate for the elderly in Jinan City,but it underestimates the LLN and may lead to the missed diagnosis of obstructive ventilatory defects.