澳門地區吸煙人群中COPD和PRISm的現況及肺功能異常與肺癌的相關性研究

A study on the prevalence of COPD and PRISm among smokers in Macao region and their relationships with the lung cancer

目的瞭解澳門地區吸煙人群中慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)和PRISm(Preserved ratio impaired spirometry,PRISm)的現況及肺功能異常與肺癌的相關性。方法2017年5月~2019年12月,對吸煙人士進行胸部低劑量CT(Low dose computed tomography,LDCT)檢查和肺通氣功能檢查,分析PRISm、COPD檢出率,並按照肺通氣功能類型分為正常組、PRISm組,和COPD組,研究三組的不同特點及與肺癌的相關性。結果291例完成了檢查,發現PRISm 32例,檢出率11.0%(95%CI:7.4%~14.6%);COPD 98例,檢出率33.7%(95%CI:28.3%~39.3%)。共檢出肺癌10例。正常組、PRISm組、COPD組的肺癌檢出率分別為0.63%、12.5%、5.1%(X2值為15.79,P<0.00)。相對於肺功能正常組,PRISm組的肺癌危險度O R為20.13(95%CI:2.33~174.20)。肺功能異常組的肺癌危險度OR為11.08(95%CI:1.39~88.57)。LDCT和肺功能診斷COPD的一致性低(Kappa=0.24,P<0.05)。結論吸煙人群中COPD檢出率高;LDCT診斷COPD的正確指數低;PRISm和肺功能異常是肺癌的危險因素,建議在吸煙人群篩查肺癌的同時進行肺通氣功能檢查篩查COPD和PRISm。

Objective To investigate the prevalence of chronic obstructive pulmonary disease(COPD)and preserved ratio impaired spirometry(PRISm)among smokers in Macao region and its relationship with lung cancer detection rates.Methods This single-arm study involved recruiting current or former smokers aged 50-75 years who were at risk of lung cancer.A baseline health questionnaire,spirometry,and low-dose CT scan were performed.CT scans were assessed by a radiologist for emphysema and lung nodules.As the spirometry technique is the gold standard,subjects were divided into three groups:the normal lung function group,the PRISm group and the COPD group.We analyzed the different characteristics of the three groups and their relationships with lung cancer detection rates.Results Among the 291 recruited subjects,32(11.0%)met the spirometry criteria for PRISm,98(33.7%)met the spirometry criteria for COPD,and 161(55.3%)had normal lung function.Ten patients had lung cancer.The lung cancer detection rates were 0.63%,12.50%,and 5.10%(X2=15.79,P<0.00)in the normal group,the PRISm group and the COPD group,respectively.The odds of lung cancer occurring in patients with PRISm syndrome and abnormal lung function(the PRISm and COPD groups)were 20-fold(20.13,95%CI=2.33-174.20)and 11-fold(11.08,95%CI=1.39-88.57),respectively(normal).lung function group,respectively.The consistency rate of LDCT and spirometry for COPD patients was low(Kappa=0.24,P<0.05).Conclusion The COPD and PRISm detection rates are high in the smoker population.COPD and PRISm are risk factors for lung cancer.There are few correlations between spirometry and LDCT in the diagnosis of COPD.Spirometry could be considered an additional test in lung cancer screening programs for heavy smokers.