肺功能“典型凹陷型图形”在慢性阻塞性肺疾病诊断中的价值

The Value of the“Typical Concave Pattern”in Pulmonary Function Test in the Diagnosis of Chronic Obstructive Pulmonary Disease

目的探讨流速-容积曲线中典型凹陷型图形在慢性阻塞性肺疾病诊断中的价值。方法回顾分析2021年10月—2022年3月以“咳嗽、咳痰、呼吸困难”为主诉且行支气管舒张试验检查的患者资料85份,患者行支气管舒张试验检查时用最强的呼气爆发力完成流速-容积曲线。分别用慢性阻塞性肺疾病诊断标准和典型凹陷型图形对其进行回顾性分析。被诊断为慢性阻塞性肺疾病的患者有54例(定义为阳性),没有被诊断为慢性阻塞性肺疾病的患者有31例(定义为阴性)。流速-容积曲线中有典型凹陷型图形的患者有52例(定义为阳性),没有典型凹陷型图形的患者有33例(定义为阴性)。绘制配对四格表资料,用McNemar检验计算其P值,并对典型凹陷型图形作为慢性阻塞性肺疾病的诊断依据进行评价。用多元线性回归分析检验慢性阻塞性肺疾病气道阻塞程度指标第一秒用力呼气容积占预计值百分比(the ratio of foced expiratory volume in one second to predicted value,FEV_(1)占预计值%)、气道限闭程度指标深吸气量占预计值百分比(the ratio of inspiratory capacity to predicted value,IC占预计值%)对典型凹陷型图形角度α大小影响的效能。结果85例符合质控要求的参与者包括67例男性和18例女性。2种检查方法在对该组研究对象诊断的阳性率差异无统计学意义(63.53%vs.61.18%,χ^(2)=82.012,P=0.625>0.05)。该图形诊断慢性阻塞性肺疾病的灵敏度为94.4%,特异度为96.8%,约登指数为91.2%。气道阻塞程度FEV_(1)占预计值%决定着典型凹陷型图形角度α的大小(VIF=1.0,标准系数=0.585)。结论用最强的呼气爆发力完成的流速-容积曲线图形中的“典型凹陷型图形”在慢性阻塞性肺疾病的诊断上与其诊断标准具有相同的价值,然而典型凹陷型图形角度α的大小却取决于气道阻塞程度(FEV_(1)占预计值%)而不是气道限闭程度(IC占预计值%)。

Objective To investigate the value of“the typical concave pattern”in flow-volume curve in the diagnosis of chronic obstructive pulmonary disease.Methods A retrospective analysis was performed on 85 patients whose chief complaints were cough,expectoration and dyspnea from October 2021 to March 2022.All patients underwent bronchial dilation test and they completed the flow-volume curve with the strongest expiratory explosive force.The diagnostic criteria of chronic obstructive pulmonary disease(COPD)and the typical concave pattern were used to analyze them retrospectively.54 patients were diagnosed with COPD and defined as positive;31 patients weren’t diagnosed with COPD and defined as negative.There were 52 patients with the typical concave pattern in the flow-volume curve and defined as positive,and 33 patients without the typical concave pattern and defined as negative.The data of paired fourfold table was drawn and their P value was calculated by McNemar test.The typical concave pattern was evaluated as the diagnostic basis of chronic obstructive pulmonary disease.Multiple linear regression analysis was used to test the effect of the ratio of foced expiratory volume in one second to predicted value(FEV_(1)/pre%)and the ratio of inspiratory capacity to predicted value(IC/pre%)on the Angleαof typical concave pattern in COPD.Results The 85 participants meeting quality control requirements included 67 men and 18 women.There was no significant difference in the positive rate of diagnosis between the two methods(63.53%vs.61.18%,χ^(2)=82.012,P=0.625>0.05).Its sensitivity value and specificity value were 94.4%and 96.8%respectively,and the Youden’s index was 91.2%in the diagnosis of chronic obstructive pulmonary disease.The index of airway obstruction(FEV_(1)/pre%)determined the size of the Angleαof typical concave pattern(VIF=1.0,standard coefficient=0.585).Conclusion The typical concave pattern in the flow-volume curve with the maximum expiratory explosive force has the same value as the criteria of chronic obstructive pulmonary disease.However,the size of Angleαof typical concave pattern is determined by the degree of airway obstruction(FEV_(1)/pre%),not the degree of collape airway(IC/pre%).