脉冲震荡肺功能测定对哮喘-慢性阻塞性肺疾病重叠患者的诊断价值

Diagnostic value of impulse oscillometry system in patients with asthma-chronic obstructive pulmonary disease

目的评估脉冲震荡(IOS)肺功能检测相关指标对诊断哮喘-慢性阻塞性肺疾病重叠(ACO)的诊断价值,并获得相关参数的界值。方法共纳入56例患者,其中单纯慢性阻塞性肺疾病(COPD)患者46例,ACO患者10例,在支气管舒张试验前后进行常规肺功能测定和脉冲震荡检测。结果ROC曲线显示,基线状态下20 Hz处阻抗预计值百分比(R20%pred)、5 Hz与20 Hz处阻抗差值(R5-R20)的曲线下面积(AUC)较高,其最佳临界值分别为117.33%和0.27,敏感度分别为0.80和0.70,特异度分别为0.74和0.72。支气管舒张试验以后,R20%pred的临界值、敏感度、特异度分别为102.78%、0.80、0.70。从支气管舒张试验前后改变量来看,当Δ(R5-R20)>0.06、电抗下面积(AX)的改变量ΔAX>0.98可以获得较满意的复合敏感度(分别为0.80和0.90)和特异度(分别为0.78和0.72)。另外,以5 Hz处的吸气相阻抗(R5in)和电抗(X5in)在支气管舒张试验前后的改变量ΔR5in>0.12、ΔX5in>0.06为折点,具有中等诊断价值。结论IOS作为ACO的辅助检查方法,具有一定的临床应用价值,有助于ACO患者与单纯COPD患者的鉴别。

Objective To evaluate the diagnostic value of impulse oscillometry system(IOS)pulmonary function test-related indicators for the diagnosis of asthma-chronic obstructive pulmonary disease overlap(ACO)and to obtain the cut-off values of relevant parameters.Methods A total of 56 patients were enrolled,including 46 patients with chronic obstructive pulmonary disease(COPD)and 10 patients with ACO.General spirometry and IOS were performed before and after bronchodilation.Results The ROC curve shows that,at the baseline state,the area under the curve(AUC)of the predicted value of the impedance at 20 Hz(R20%pred)and the impedance difference at 5 Hz and 20 Hz(R5-R20)is higher.The optimal threshold values are 117.33%and 0.27,respectively,and the sensitivity is 0.80 and 0.70,the specificity is 0.74 and 0.72 respectively.After the bronchodilation test,the threshold value,sensitivity,and specificity of R20%pred-post were 102.78%,0.80,and 0.70,respectively.From the changes before and after the bronchialdilation test,whenΔ(R5-R20)>0.06 and the area under the reactanceΔAX>0.98,satisfactory composite sensitivity(0.80 and 0.90,respectively)and specificity(0.78 and 0.72,respectively)were obtained.In addition,the variables of inspiratory phase impedance and reactance at 5 Hz before and after the bronchial dilation test,ΔR5in>0.12,ΔX5in>0.06 are the breakpoints,with moderate diagnostic value.Conclusions As an auxiliary examination method of ACO,IOS has certain clinical application value,which is helpful for the differentiation of ACO patients and patients with simple COPD.