肺功能检查研究进展2017

Research progress of pulmonary function testing in 2017

2017年,中国发布了肺功能检查指南——呼气峰值流量及其变异率指南,推出了覆盖4~80岁人群肺通气功能预计值方程。同年,国外发布或更新了肺的一氧化碳弥散量测量预计值及支气管激发试验指南。美国胸科学会首次提出了标准化肺功能报告的建议,并推荐使用采用正常值下限或Z值作为异常阈值的判读。复杂型限制性通气功能障碍的概念被提出,即用力肺活量及肺总量不成比例地下降,其可能提示肺排空过程障碍,如神经肌肉疾病、隐匿性的气道阻塞及胸廓活动受限。慢性阻塞性肺疾病(简称慢阻肺)患者吸气相及呼气相电抗之差的增高可提示其运动耐量更差、急性加重及住院次数更多,病死率更高,并可用于选择呼吸支持治疗的水平。为减少慢阻肺患者的漏诊,除了吸烟人群,也应在有症状的人群进行肺功能筛查。少年儿童时期的肺功能筛查有助于早期发现疾病高风险人群。慢阻肺早期干预可显著改善肺功能及减缓肺功能下降。

Technical standard and interpretation for measurement of peak expiratory flow and its variability, as well as update spirometry references for Chinese aged 4-80 years old, were published in China in 2017. Updated standards for single-breath carbon monoxide uptake in the lung and for bronchial challenge testing were recommended by ERS/ATS. For the first time, ATS came up with a standardized pulmoary function report, and recommended to use the lower limit of normal or Z score to be a cut-off abnormal value The complex restrictive pulmonary fimctioa pattern, which the reduction of forced vital capacity （FVC） is disproportionate to the reduction of total lung capacity （TLC）, indicates incomplete lung emptying, such as neuromuscular disease, chest wall limitation and occult air trappingr Increased difference of reactance between expiratory phase and inspiratory phase of breath in chronic obstructive pulmonary disease （COPE）） patients is associated with a deterioration in exercise performance, more exacerbations and hospitalizations, and a higher mortality, which can also be validated to help determining the optimal level of respiratory support. To minimize the underdiagnoses of COPD, spirometry screening is recommended to all symptomatic individuals, except the smoking population, Pulmonary function screening in early life helps detect individuals with high risks of respiratory disease,Intervention in early stage of COPD can improve pulmonary function significantly and ameliorate the decline of pulmonary function.