FEV1/FEV6截断值在阻塞性通气功能障碍中的诊断价值

Diagnostic value of FEV1/FEV6 cutoff value in obstructive ventilatory dysfunction

目的探讨FEV1/FEV6截断值在阻塞性通气功能障碍中的诊断价值,为检测气道阻塞提供替代方案。方法回顾性分析2016年1月至2019年7月在中山大学附属第三医院行肺功能检查的患者报告共1112份,收集患者的一般资料及肺功能的相关指标。根据慢性阻塞性肺疾病全球倡议(The GlobalInitiative for Chronic Obstructive Lung Disease,GOLD)对慢性阻塞性肺疾病诊断标准(舒张试验后FEV1/FVC<70%)绘制接受者操作特性曲线(receiver operating characteristic curve,ROC)以确定FEV1/FEV6的最佳截断值。结果ROC曲线下面积:0.996(95%CI:0.989~1.000),P<0.001,根据约登指数(Youden index,YI)最大值确定FEV1/FEV6<71%为最佳截断值,该截断值的敏感度、特异度、阳性预测值、阴性预测值和约登指数分别为96.4%、99.5%、98.6%、98.7%、95.9%,具有较高的敏感度与特异度。结论截断值FEV1/FEV6<71%可作为FEV1/FVC<70%替代指标诊断阻塞性通气功能障碍。

Objective To investigate the diagnostic value of FEV1/FEV6 cut-off value in obstructive venti-latory dysfunction and provide an alternative to the detection of airway obstruction.Methods A retrospective analysis of 1,112 patients who underwent pulmonary function tests in the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to July 2019 was conducted to collect general information of the patients and related indicators of lung function.The receiver operating characteristic curve(ROC)was plotted according to the The Global Initiative for Chronic Obstructive Lung Disease(GOLD)diagnostic criteria for chronic obstructive pulmonary disease(FEV1/FVC<70%after bronchial dilation test)to determine the optimal cutoff value for FEV1/FEV6.Results The area under the ROC curve was 0.996(95%CI:0.989~1),P<0.001.According to the maximum value of Youden index,FEV1/FEV6<71%was determined as the best cutoff value.Sensitivity,specificity,positive predictive value,negative predictive value and Youden index were 96.4%,99.5%,98.6%,98.7%and 95.9%,respectively,indicating high sensitivity and specificity.Conclusion Cutoff value FEV1/FEV6<71%can be used as a surrogate index for FEV1/FVC<70%to diagnose obstructive ventilatory dysfunction.