脉冲振荡检测在慢性阻塞性肺疾病和支气管哮喘鉴别诊断中的价值

Differential diagnostic value of impulse oscillometry in chronic obstructive pulmonary disease and bronchial asthma

目的分析脉冲振荡检测(IOS)参数在慢性阻塞性肺疾病(COPD)和支气管哮喘(哮喘)中的差异,建立基于IOS参数的COPD和哮喘鉴别诊断模型,探讨IOS在评估COPD严重程度中的价值。方法本研究为横断面研究。采用目的抽样法,回顾性收集2021年1月至2023年9月于郑州大学第一附属医院就诊的确诊为COPD的患者133例和哮喘患者112例,分别纳入COPD组和哮喘组,入组患者均配合完成IOS检查。提取患者的临床资料,分析IOS参数[共振频率(Fres)、5 Hz时的阻力(R5)、R5占预计值百分比(R5%pred)、20 Hz时的阻力(R20)、R20占预计值百分比(R20%pred)、5 Hz和20 Hz时阻力的差值(R5-R20)、5 Hz时的电抗(X5)]与肺量计参数[第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值百分比(FEV_(1)%pred)、FEV_(1)/用力肺活量(FVC)]之间的相关性,通过t检验或Mann-WhitneyU检验分析2组IOS参数的差异,并将IOS参数纳入多因素logistic回归分析,筛选鉴别COPD的独立影响参数以构建诊断模型,并通过受试者操作特征曲线评估模型和IOS独立参数的诊断效能。根据慢性阻塞性肺疾病全球倡议(GOLD)分级,将COPD组患者分为GOLD 1-2组、GOLD 3-4组,进一步研究IOS对COPD严重程度评估的价值。结果COPD组133例,其中男101例,女32例,年龄(60.12±11.44)岁;哮喘组112例,其中男51例,女61例,年龄(46.48±15.43)岁。Spearman相关分析结果显示,IOS参数Fres、R5、R5%pred、R20、R20%pred、R5-R20与肺量计参数(FEV_(1)、FEV_(1)%pred、FEV_(1)/FVC)呈负相关,X5与上述肺量计参数呈正相关(rs值分别为0.758、0.719、0.693,均P<0.001)。COPD组IOS参数Fres[(29.37±9.65)L/s比(14.80±5.31)L/s]、R5[(0.71±0.25)kPa·s/L比(0.44±0.14)kPa·s/L]、R5%pred[(218.71±72.11)%比(128.00±37.05)%]、R20[(0.41±0.10)kPa·s/L比(0.37±0.09)kPa·s/L]、R20%pred[(148.62±32.95)%比(127.12±29.54)%]、R5-R20[0.28(0.15,0.40)kPa·s/L比0.06(0.02,0.10)kPa·s/L]均高于哮喘组,X5[(-0.32±0.21)kPa·s/L比(-0.11±0.05)kPa·s/L]低于哮喘组(t=14.89,t=11.08,t=12.66,t=3.84,t=5.33,Z=10.19,t=11.23,均P<0.001)。多因素logistic回归筛选的鉴别COPD的独立影响参数为Fres和X5,基于二者构建的诊断模型诊断COPD性能最佳(曲线下面积为0.919)。COPD亚组分析结果显示,GOLD 3-4组Fres、R5、R5%pred、R5-R20高于GOLD 1-2组,X5低于GOLD 1-2组(均P<0.001)。结论IOS在COPD和哮喘的鉴别以及COPD严重程度评估方面具有重要价值,基于Fres和X5构建的COPD鉴别诊断模型具有较高的准确性,对于COPD和哮喘难以鉴别或者不能耐受肺量计检查的患者具有重要的临床价值。

Objective To analyze the differences of impulse oscillometry system(IOS)parameters between chronic obstructive pulmonary disease(COPD)and bronchial asthma(asthma),to establish a differential diagnosis model based on IOS parameters for COPD and asthma,and to explore the value of IOS in evaluating the severity of COPD.Methods This study was a cross-sectional study.A purposive sampling method was used.A retrospective collection was conducted on 133 patients diagnosed with COPD and 112 patients with asthma who were treated at the First Affiliated Hospital of Zhengzhou University from January 2021 to September 2023.They were respectively included in the COPD group and asthma group,and all enrolled patients cooperated in completing IOS examinations.The patients′clinical data were extracted,the correlation between IOS and spirometry was analyzed,t-tests or Mann Whitney U-tests was used to analyze the differences of IOS parameters(Fres,R5,R5%pred,R20,R20%pred,R5-R20,and X5)between the two groups,and IOS parameters were incorporated into multivariate logistic regression analysis to screen independent influencing parameters for distinguishing COPD and to construct a diagnostic model.The diagnostic efficacy of the model and IOS independent parameters were evaluated through receiver operating characteristic(ROC)curves.Finally,based on the GOLD grading,COPD patients were divided into GOLD 1-2 group and GOLD 3-4 group to further investigate the value of IOS in assessing the severity of COPD.Results This study included 245 patients,with 133 COPD patients and 112 asthma patients.There were 101 males and 32 females in the COPD group,aged(60.12±11.44)years old.There were 51 males and 61 females in the asthma group,aged(46.48±15.43)years old.Spearman correlation analysis showed that the IOS indicators Fres,R5,R5%pred,R20,R20%pred,and R5-R20 were negatively correlated with lung volume parameters(FEV_(1),FEV_(1)%pred,and FEV_(1)/FVC),while X5 was positively correlated with the aforementioned lung volume parameters(rs values were 0.758,0.719,0.693,P<0.001).Compared with the asthma group,the levels of various IOS parameters Fres([29.37±9.65]L/s vs[14.80±5.31]L/s),R5([0.71±0.25]kPa·s/L vs[0.44±0.14]kPa·s/L),R5%pred([218.71±72.11]%vs[128.00±37.05]%),R20([0.41±0.10]kPa·s/L vs[0.37±0.09]kPa·s/L),R20%pred([148.62±32.95]%vs[127.12±29.54]%),and R5-R20(0.28[0.15,0.40]kPa·s/L vs0.06[0.02,0.10]kPa·s/L)were significantly higher,X5([-0.32±0.21]kPa·s/L vs[-0.11±0.05]kPa·s/L)was lower in the COPD group(t=14.89,t=11.08,t=12.66,t=3.84,t=5.33,Z=10.19,t=11.23,all P<0.001).The independent influencing parameters for COPD selected by multivariate logistic regression are Fres and X5,and the diagnostic model constructed based on the two has the best diagnostic performance for COPD(area under curve was 0.919).COPD subgroup analysis showed that compared with the GOLD 1-2 group,Fres,R5,R5%pred,and R5-R20 were increased,X5 was decreased in the GOLD 3-4 group(all P<0.001).Conclusions IOS is valuable in differentiating COPD and asthma as well as in assessing COPD severity,and the COPD differential diagnosis model constructed based on Fres and X5 shows high accuracy,which is clinically valuable for cases difficult to differentiate between COPD and asthma or for patients who are intolerant to spirometry.