肺功能检查临床应用研究进展(2022-2023)

Research progress in clinical application of pulmonary function testing(2022-2023)

本文针对2022年6月1日至2023年5月31日的肺功能检查临床应用研究进展总结评价。期间,我国发布了肺功能检查技术规范——脉冲振荡技术(IOS)检查,对IOS的检查方法、质量控制提出技术规范和临床应用建议;并发布了开展便携式肺功能检查的中国专家共识。我国的肺量计国家卫生行业标准2023年5月1日起正式实施。我国分别建立了适用于中国健康成人及4~17岁儿童IOS的参考值和预计值方程式;建立了适用于科普、基层推广和疾病早期筛查的基于第1秒用力呼气容积、用力呼出50%肺活量的呼气流量和用力呼出75%肺活量的呼气流量三项呼气流量指标的肺龄评估方程。在肺功能评估及临床应用方面,国内外多项研究结果显示肺功能损害受基因和环境等因素影响,肺功能发育轨迹异常的早期识别为肺功能损害治疗提供了早期预防和治疗的机会。慢性阻塞性肺疾病(COPD)的诊断需结合临床与肺功能,肺一氧化碳弥散量可预测COPD恶化风险和病死率等,可考虑纳入COPD的多维评估工具。IOS可预测学龄前哮喘儿童学龄时期的肺功能。新型冠状病毒感染后需注意肺功能长期随访,以及肺功能异常和症状的治疗。第1秒用力呼气容积和用力肺活量可为心血管疾病死亡风险预测和预后提供信息,监护和维持肺功能有助于预防痴呆。

This article reviews the clinical application of lung function testing from June 1,2022 to May 31,2023.During this period,China has released the technical specifications for lung function testing——Pulse Oscillation Technique(IOS),proposing technical specifications and clinical application suggestions for the examination method and quality control of IOS.Consensus of Chinese experts on portable spirometer was also published.The national health care industry standards for spirometry in China were officially implemented on May 1,2023.Reference values of IOS were established for healthy Chinese adults and children aged 4-17 years.Lung age estimation equations based on expiratory flow indices such as forced expiratory volume in the first second,forced expiratory flow at 50%of FVC,and forced expiratory flow at 75%of FVC were developed,which are appropriate for science popularization,promotion in primary health institutions,and early screening of diseases.In the aspects of lung function assessment and clinical application,studies at home and broad have shown that pulmonary damage is influenced by genes and environment.Identifying early lung function development abnormalities can provide opportunities for early prevention and treatment of lung function damage.The diagnosis of chronic obstructive pulmonary disease(COPD)needs to combine clinical features and pulmonary function.Lung diffusing capacity for carbon monoxide can predict COPD exacerbation risk and mortality,and can be considered as a multidimensional assessment tool for COPD.IOS can predict lung function in preschool children with asthma during school age.Long-term follow-up of pulmonary function and treatment of pulmonary damage and symptoms from post-COVID-19 effects should be paid attention to.Forced expiratory volume in the first second and forced vital capacity can provide prognostic and predictive value for the mortality in patients with cardiovascular diseases.Monitoring and maintaining the pulmonary function among older adults can help prevent dementia.