社区老年人群慢性阻塞性肺疾病筛查及其危险因素分析

Screening of COPD and analysis of its risk factors in a community-based elderly population

目的 使用基层慢性阻塞性肺疾病(简称慢阻肺)筛查问卷联合肺功能检查对60岁以上社区人群进行慢阻肺筛查,分析其在社区慢阻肺诊断中的作用;比较慢阻肺组和非慢阻肺组的特征,分析慢阻肺的患病高危因素。方法 对2019年6月10日至2020年11月10日象山县第一人民医院医疗健康集团丹城分院60岁以上参加老年体检的人群使用基层版慢阻肺筛查问卷进行问卷调查,同时收集一般资料,根据胸部X线及简易肺功能检查结果,将调查人群分为慢阻肺组和非慢阻肺组。分析两组数据,进行慢阻肺危险因素调查,计算慢阻肺筛查问卷对慢阻肺诊断的灵敏度及特异度。结果 共筛查1004例60岁以上居民,诊断慢阻肺为219例,检出率为21.81%(219/1004)。慢阻肺组筛查问卷分值为(5.73±1.03)分,非慢阻肺组为(3.83±1.02)分,差异有统计学意义(P <0.001)。多因素分析发现,年龄≥65岁、体重指数(BMI)<18.5 kg/m^(2)、慢阻肺筛查问卷评分≥5分均为慢阻肺的患病独立危险因素,差异有统计学意义(P <0.05)。慢阻肺筛查问卷评分≥5分时,诊断慢阻肺的灵敏度为95.89%,特异度为79.87%,约登指数为最大0.75。结论 基层慢阻肺筛查问卷联合肺功能检查可以作为基本工具在社区对60岁以上的人群进行筛查,能提高慢阻肺的诊断率。

Objective To screen for chronic obstructive pulmonary disease(COPD) in a group of community-based populations aged 60 years or older using the COPD screening questionnaire for grassroots combined with pulmonary function tests, and to analyze the role of such combination in the diagnosis of COPD in the community;to compare the characteristics of the COPD group and the non-COPD group, so as to analyze the high-risk factors for the development of COPD. Methods Residents aged 60 years or older attending geriatric physical examinations in the community under the jurisdiction of Dancheng Branch of Xiangshan First People’s Hospital Medical and Health Group from June 10, 2019 to November 10, 2020 were surveyed by the COPD screening questionnaire for grassroots, and their clinical data were collected. The surveyed population was divided into the COPD group and the non-COPD group based on chest X-ray and simplified pulmonary function test results. The data of the two groups were analyzed, the risk factors of COPD were investigated, and the sensitivity and specificity of the COPD screening questionnaire for diagnosis were calculated. Results A total of 1004 residents aged 60 years or older were screened, and 219 were diagnosed with COPD, with a detection rate of 21.81%(219/1004). The COPD screening questionnaire score was(5.73±1.03) in the COPD group and(3.83±1.02) in the non-COPD group, with statistically significant differences between the two groups(P < 0.001).Multivariate analysis revealed that age ≥ 65 years, body mass index(BMI) < 18.5 kg/m^(2), and COPD screening questionnaire score ≥ 5 were all independent risk factors for the development of COPD, with statistically significant differences(P < 0.05). It was found that when the COPD screening questionnaire score was ≥ 5, the sensitivity and specificity for the COPD screening questionnaire in diagnosing COPD were 95.89% and 79.87% respectively, and the Youden index was 0.75(max). Conclusion Grass-roots COPD screening questionnaire combined with pulmonary function examination can be used as a basic tool to screen patients over 60 years old in the community, and can improve the diagnosis rate of COPD.