慢性阻塞性肺疾病的肺功能诊断标准及其局限性  

The Lung Function Criterion for COPD and Its Limitation

作　　者：罗勇[1,2] 

机构地区：[1]交通大学医学院附属新华医院崇明分院呼吸科,202150 [2]上海交通大学医学院附属新华医院呼吸科,上海200092

出　　处：《临床误诊误治》2011年第11期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：上海市慢性病综合防治项目(SHDC12007301)

摘　　要：《慢性阻塞性肺疾病全球防治倡议》和我国《慢性阻塞性肺疾病诊治指南》规定的慢性阻塞性肺疾病(chronicobstructive pulmonary disease,COPD)肺功能诊断标准均为吸入支气管舒张剂后第1秒钟用力呼气容积/用力肺活量(FEV1/FVC)<0.70。然而,FEV1/FVC的比值与受试者的年龄、身高、性别、种族、呼吸肌力等多种因素相关,现有证据证明FEV1/FVC比值与受试者的年龄呈反比,当前这一全球统一的诊断标准正受到前所未有的挑战。采用FEV1/FVC<0.70这一固定不变的数值诊断气流受限,对于老年人有过度诊断之虞,而对于年轻人又有漏诊之嫌。故对临床上无吸烟史、无有害气体暴露史,且无症状的老年人,即便FEV1/FVC<0.70也不宜轻易诊断COPD。That post bronchodilator FEV1/FVC0.70 is the lung function criterion for COPD has been recommended by the position papers of Global Initiative for Chronic Obstructive Lung Disease and Chinese Guideline of Diagnosis and Management for COPD.But the ratio of FEV1/FVC varies with age,height,gender,ethnic group and respiratory muscle strength.At present,the fixed threshold faces great challenges as there is much evidence to demonstrate that measured lung function value is negatively proportional to age.FEV1/FVC ratio of 0.70 in fixed numerus diagnosis the patients with airflow obstruction have the risk of missed diagnosis of sapling,and the risk of over diagnosis of the elderly.So COPD should not be easily diagnosised in asymptomatic patients with non-smoking history and non-harmful gas exposure history even if FEV1/FVC is0.70.

关 键 词：肺疾病 慢性阻塞性 呼吸功能 诊断标准 误诊 漏诊 

分 类 号：R563.9[医药卫生—呼吸系统]