深吸气量和中医临床症状评分表在COPD中的应用研究

目的 评价深吸气量(IC)和中医临床症状评分表(CMSS)在诊断慢性阻塞性肺疾病(COPD)的应用价值.方法 选择22例COPD患者及21例非COPD患者,测量支气管舒张试验前后肺通气功能,采用中医临床症状评分表和呼吸困难量表进行评估患者症状,统计分析各肺功能指标的变化及相关性,探索深吸气量和中医症状量表诊断COPD的临床价值.结果 COPD组基础值IC、吸药后IC、IC改善率与非COPD组相比无明显差异,但ΔIC明显大于非COPD组(P<0.05).COPD组吸药前后第1秒用力呼气容积(FEV1)均小于非COPD组(P<0.01,P<0.01),ΔFEV1、FEV1改善率均大于非COPD组(P<0.05,P<0.01).COPD组ΔFVC、FVC改善率明显大于非COPD组(P<0.01,P<0.01).COPD组基础值呼气流量峰值(PEF)、吸药后PEF明显小于非COPD组(P<0.01).在症状评估方面,COPD组和非COPD组的TCMSS有统计学差异,而呼吸困难量表评分无明显差异.ΔIC与ΔFVC呈正相关(r=0.46,P=0.03),与ΔFEV1、ΔPEF无明显相关性(r=0.06,P=0.77;r=0.26,P=0.25).以ΔIC诊断COPD,ROC曲线下面积为0.69,临界值0.05L,敏感性63.64%,特异性71.43%.以IC改善率诊断气道可逆性,ROC曲线下面积为0.69,临界值2.28%,敏感性68.18%,特异性71.43%.结论 IC在评价轻中度COPD患者对支气管舒张剂的气道反应性方面具有一定的敏感性,但不如FEV1.IC在诊断COPD上具有较好的敏感性及特异性,中医症状评分表在COPD诊断和症状评估方面,涵盖内容更广,能补充呼吸困难量表的不足.

Objective To evaluate the diagnostic value of inspiratory capacity(IC) and Chinese medical symptom scale in chronic obstructive pulmonary disease(COPD). Methods A total of 22 COPD patients and 21 non-COPD patients were enrolled. Pulmonary function test was performed before and after the bronchial dilation test(BDT).The symptoms of patients were evaluated by Chinese medical symptom scal(CMSS) and dyspnea scale(mMRC).Statistical methods were used to analyze the change of IC and other pulmonary function parameters,and to find the critical value of IC for COPD diagnosis. Results When compared with the non-COPD group,the COPD group showed:higher ΔIC(P<0.05) and comparable base value of IC,IC value after BDT and improvement rate of IC lower base value of FEV1 (P<0.01),FEV1 value after BDT (P<0.01) and higher ΔFEV1 (P<0.05),improvement rate of FEV1(P<0.01). higher ΔFVC(P<0.01) and improvement rate of FVC (P<0.01). Lower base value of PEF (P<0.01) and PEF value after BDT (P<0.01).In terms of symptom assessment,CMSS had statistical difference between COPD group and non-COPD group,while the score of dyspnea scale had no difference. ΔIC was relevant with ΔFVC in the COPD group (r=0.46,P=0.03) and wasn’t related with ΔFEV1 or ΔPEF.In ROC analysis:ΔIC presents an AUC of 0.69,the cutoff value is 0.05L,with a sensitivity of 63.64% and specificity of 71.43% improvement rate of IC presents an AUC of 0.68,the cutoff value is 2.28%, with a sensitivity of 68.18% and specificity of 71.43%. Conclusion IC is a sensitive indicator for evaluating the response of bronchial dilation test in mild-moderate COPD patients,but it’s not as sensitive as FEV1 in a certain extent.The CMSS covers a wider range of contents in the diagnosis and evaluation of COPD,and can be a supplement for the dyspnea scale.