肺功能舒张试验对慢性阻塞性肺疾病早期诊断的价值

Value of diastolic lung function test in the early diagnosis of chronic obstructive pulmonary disease

目的分析基础肺功能符合第1秒用力呼气容积占预计值百分比(FEV1%pred)≥70%但一秒率(FEV1/FVC)<70%患者的基线资料及肺功能特点,探讨肺功能舒张试验对慢性阻塞性肺疾病(COPD)早期诊断的价值。方法收集2017-07~2018-05山西医科大学第二医院呼吸内科就诊,基础肺功能符合FEV1%pred≥70%但FEV1/FVC<70%的患者共396例,其中274例进行了支气管激发试验,122例进行了支气管舒张试验。将行舒张试验患者分为两组:舒张不可逆组(舒张试验后FEV1/FVC<70%)和舒张可逆组(舒张试验后FEV1/FVC≥70%),分析舒张不可逆组与舒张可逆组患者的基线资料及肺功能指标特点。结果①122例患者舒张试验后的FEV1/FVC与年龄、舒张前FEV1/FVC、舒张前用力呼气至75%肺活量时的呼气流速占预计值百分比(MEF75%pred)、舒张前用力呼气至50%肺活量时的呼气流速占预计值百分比(MEF50%pred)、舒张前最大呼气中段流速占预计值百分比(MMEF%pred)均存在相关性,相关系数r分别为:-0.526,0.648,0.399,0.355,0.188,而与舒张前FEV1%pred之间不存在相关性。②舒张不可逆组年龄≥40岁及男性所占比例高于舒张可逆组(P<0.05)。结论基础肺功能FEV1%pred≥70%但FEV1/FVC<70%的患者进行激发试验后会漏诊COPD早期患者,建议男性、年龄≥40岁以及肺功能FEV1/FVC、MEF75%pred、MEF50%pred、MMEF%pred基线水平较低者首先进行舒张试验,以提高COPD早期诊断,减少漏诊。

Objective To analyze the baseline data and lung function characteristics of patients with basic lung function FEV 1%pred≥70%but FEV 1/FVC<70%,and explore the value of diastolic lung function test in the early diagnosis of chronic obstructive pulmonary disease.Methods The clinical data of 396 cases of basic lung function FEV 1%pred≥70%but FEV 1/FVC<70%in the Second Hospital of Shanxi Medical University from July 2017 to May 2018 were analyzed retrospectively.Of them,274 patients underwent excitation test and 122 patients underwent bronchial diastolic test.Patients undergoing diastolic test were divided into two groups:diastolic irreversible group(FEV 1/FVC<70%after diastolic test),and diastolic reversible group(FEV 1/FVC≥70%after diastolic test).The baseline data and lung function characteristics were compared between the two groups.Results①The post-diastolic FEV 1/FVC in 122 patients was correlated with age(r=-0.526),pre-diastolic FEV 1/FVC(r=0.648),pre-diastolic MEF75%(r=0.399),pre-diastolic MEF50%(r=0.355),and pre-diastolic MMEF%(r=0.188),but not with FEV 1%pred.②The proportions of males and age over 40 years in diastolic irreversible group were higher than those in diastolic reversible group(P<0.05).Conclusion COPD patients with basic lung function FEV 1%pred≥70%but FEV 1/FVC<70%may be missed diagnosis in the clinic after excitation test.The results suggest that patients with male,age≥40 years,and low level of baseline FEV 1/FVC,MEF75%pred,MEF50%pred,MMEF%pred should first undergo a diastolic test to improve the early diagnosis and reduce the early missed diagnosis of COPD.