慢性阻塞性肺疾病患者用力肺活量最佳替代指标的探讨  

Investigation of the optimal surrogate for forced vital capacity in the diagnosis for chronic obstructive pulmonary disease

作　　者：杜秀然[1] 李幸彬[2] 耿书军[2] 杨凤[3] 陈素丽[2] 

机构地区：[1]河北省胸科医院胸外科,石家庄050041 [2]河北省胸科医院结核呼吸内科,石家庄050041 [3]河北省胸科医院肺功能室,石家庄050041

出　　处：《中国综合临床》2013年第7期710-713,共4页Clinical Medicine of China

基　　金：河北省科学技术研究与发展计划项目（11276103D-5）

摘　　要：目的评估第6秒用力呼气容积（FEV6）是否为替代用力肺活量（FVC）用于诊断慢性阻塞性肺疾病（COPD）的最佳指标。方法对2011年10月至2012年10月河北省胸科医院收治的142例舒张后用力呼气时间达6s以上的COPD患者（轻度7例，中度60例，重度48例，极重度27例）肺功能检查结果进行回顾性分析，在时间一容量曲线上测量FEV6、FEV5、FEV4、FEV3，对其诊断效能进行分析。结果FEV6、FEV5、FEV4、FEV3与FVC高度相关（r值分别为0．994、0．939、0．935、0．923，P均〈0．001）。以70％为诊断界点，FEV1／FEV6的诊断率为92．96％，假阴性率为7．04％，FEV1／FEV5、FEV1／FEV4、FEV1／FEV3的假阴性率更高，分别为9．86％、13．38％、27．46％。轻、中度组和重度、极重度组COPD患者的FEV1／FEV6-FEV1／FVC值差异无统计学意义（t=1．376，P=0．171）。结论FEV6与FVC高度相关，为替代FVC用于诊断COPD的最佳指标，适当提高诊断界值可减降低假阴性率。Objective To evaluate whether the forced expiratory vdume in sixth scend（ FEV6 ） was the optimal surrogate for forced vital capacity （ FVC ） in the diagnosis for chronic obstructive pulmonary disease （COPD）. Methods Retrospectively analyzed the spirometric data of 142 COPD patients （7 cases with mild COPD,60 cases with moderate COPD,48 cases with severe COPD, 27 cases with extremely severe COPD） admitted to Hebei Chest Hospital from October 2011 to October 2012 who had FEV6 data. FEV6, FEVs, FEV4 and FEV3 were measured on volume-time curves and the diagnostic value was analyzed. Results FEV6,FEVs, FEV4 and FEVa were highly correlated to FVC （ r =0. 994,0. 939,0. 935 and 0. 923 respectively, P 〈 0. 001 ）. Assuming = 70% as the diagnostic standard for obstruction, FEV1/FEV6 had a diagnostic rate of 92. 96% with a false negative rate of 7.04%. FEVI/FEVs, FEV1/FEV4 and FEVJFEV3 had higher false negative rates （9. 86%, 13.38% and 27.46% respectively） than FEV6. The value of FEVI/FEV6 - FEVI/FVC had no statistical significance between the mild-moderate and the severe-extremely severe COPD groups（ t = 1. 376 ,P = 0. 171 ）. Conclusion There is a strong correlation between FEV6 and FVC. FEV6 may be the best surrogate for FVC in the diagnosis of chronic obstructive pulmonary disease. Elevating diagnostic critical value can reduce the false negative rate.

关 键 词：第6秒用力呼气容积 第5秒用力呼气容积 第4秒用力呼气容积 用力肺活量 慢性阻塞性肺疾病 肺功能检查 

分 类 号：R563.9[医药卫生—呼吸系统]