最大呼气流量-容积曲线下降支夹角在慢性阻塞性肺疾病和支气管哮喘评估中的价值  

Value of Angle in Descending Limb of Maximum Expiratory Flow-Volume Curve for Evaluation of Chronic Obstructive Pulmonary Disease and Bronchial Asthma

作　　者：李丽[1] 朱蕾[1] 陈琪[1] 杨延杰[1] 张志凤[1] 于金娣[1] 

机构地区：[1]复旦大学附属中山医院肺科,上海200032

出　　处：《中国呼吸与危重监护杂志》2011年第2期181-185,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：上海市科学技术委员会科研计划项目课题[编号:科委2009第22081号(2)]

摘　　要：目的探讨最大呼气流量-容积(MEFV)曲线下降支夹角在慢性阻塞性肺疾病(COPD)与支气管哮喘(哮喘)评估中的价值。方法选择2008年11月至2009年12月在中山医院就诊的阻塞性通气功能障碍患者306例,其中COPD 157例,哮喘149例,测量MEFV曲线下降支夹角α,进行统计学分析。以COPD为试验组,哮喘为对照组,绘制α的ROC曲线并计算曲线下面积。结果随阻塞程度的加重,COPD患者的α变小(P<0.01),α补角的正切值TAN与FEV1.0呈明显负相关(r=-0.640,P=0.000);而哮喘患者基本不变(P>0.05),且其补角的正切值TAN与FEV1.0有较低程度的负相关(r=-0.206,P=0.012)。轻度阻塞时,COPD和哮喘患者的α相似(P=0.177)。中、重度阻塞时,COPD患者的α皆显著小于哮喘患者(皆为P=0.000)。轻度阻塞时,ROC曲线下的面积为0.431;中度阻塞时为0.846,最佳阈值135.5°,诊断COPD的敏感度81.7%,特异度74.2%,阳性预测值75.4%,阴性预测值80.7%;重度阻塞时为0.928,最佳阈值129.5°,诊断COPD的敏感度87.5%,特异度84.0%,阳性预测值91.3%,阴性预测值77.8%。结论反映MEFV曲线下降支凹陷程度的夹角α的大小可以反映COPD患者阻塞的严重程度,但仅能反映哮喘患者气道阻塞的存在,有助于进一步阐明两者的病理、病理生理特点和进行鉴别诊断。Objective To explore the clinical value of measuring angle alpha(α) in the descending limb of maximum expiratory flow-volumem(MEFV) curve in chronic obstructive pulmonary disease(COPD) and bronchial asthma.Methods From MEFV curves,angle α and other parameters were measured in 157 individuals with COPD and 149 patients with asthma who received pulmonary function test in Zhongshan Hospital,from November 2008 until December 2009.The results were grouped and analyzed.The area under ROC curve of the angle α was measured in the patients with COPD and compared with asthma.Results The angle α lessened with the increasing degree of airway obstruction in the patients with COPD and asthma(P<0.01,P>0.05).Tangent(180-α) and FEV1.0 were correlated either in the COPD group or in the asthma group(r=-0.640,P=0.000;r=0.206,P=0.012).There was no statistical difference in the angle α between the COPD group and the asthma group when the patients had mild obstructive ventilation disorders(P=0.177).The angle α in the COPD group was smaller than that in the asthma group when the patients had moderate and severe obstructive ventilation disorders(P=0.000,P=0.000).Area under ROC curves of the angle α in the patients with COPD who had mild,moderate and severe obstructive ventilation disorders were 0.431,0.846 and 0.928 respectively.In moderate obstructive ventilation disorders,the optimal diagnostic cutoff point was 135.5 degree which was capable of differentiating COPD and asthma with a sensitivity of 81.7%,a specificity of 74.2%,a positive predictive value of 75.4%,and a negative predictive value of 80.7%.In severe obstructive ventilation disorders,the optimal diagnostic cutoff point was 129.5 degree with a sensitivity of 87.5%,a specificity of 84.0%,a positive predictive value of 94.3%,and a negative predictive value of 77.8%.Conclusions Angle α in the descending limb of MEFV curve can assess the degree of airway obstruction in COPD,whereas it just reflect the presence of airway obstruction in asthma.Differences in Angle α are

关 键 词：慢性阻塞性肺疾病 支气管哮喘 最大呼气流量-容积曲线 

分 类 号：R562.25[医药卫生—呼吸系统] R563.9[医药卫生—内科学]