探究峰流速仪呼气峰流速检测对慢性阻塞性肺疾病的筛查效力  

The Effectiveness of Peak Flow Meter in COPD Screening

作　　者：刘亚男[1] 许文兵[1] 孟淑珍[1] 赵阳[1] 官微微 

机构地区：[1]中国医学科学院北京协和医院呼吸内科,北京100730

出　　处：《中国呼吸与危重监护杂志》2015年第3期250-254,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨峰流速仪呼气峰流速(PEF)检测对不同程度慢性阻塞性肺疾病(简称慢阻肺)人群筛查的敏感性。方法选取2013年5月至2014年12月在北京协和医院呼吸内科门诊确诊的156例慢阻肺患者,采集患者病史、症状、危险因素暴露史、近1年急性加重次数和合并症等资料,并进行6分钟步行测试,测评慢阻肺评估测试(CAT)、改良英国医学研究委员会呼吸问卷(m MRC)和圣乔治呼吸问卷(SGRQ)。同时采用肺功能仪测量通气功能以及峰流速仪测量PEF。结果以PEF占预计值百分比(PEF%pred)=80%为截断值,156例患者中筛查出120例(76.9%),36例被判定为漏诊人群。影响慢阻肺人群能否被峰流速仪筛查出的因素为FEV1%pred与SGRQ总分(P<0.01)。PEF筛查慢阻肺患者的整体敏感性为76.9%,对轻度气流受限患者的敏感性为27.7%,对中度气流受限患者的敏感性为68.5%,对重度~极重度气流受限患者的敏感性为98.5%,对中度~极重度气流受限患者的敏感性为83.3%;对CAT<10患者的敏感性为48.3%,对m MRC<2患者的敏感性为60.0%,对SGRQ<25患者的敏感性为30.0%;对CAT≥10患者的敏感性为87.5%,对m MRC≥2患者的敏感性为90.9%,对SGRQ≥25患者的敏感性为90.0%;对A级患者的敏感性为35.2%,对B级患者的敏感性为75.0%,对慢阻肺高危人群(C^D级)的敏感性为95.9%。以80%为截断值,峰流速筛查对早期慢阻肺患者(肺功能GOLD 1级、症状轻、慢阻肺综合评估A级)的敏感性较低;当截断值调整为95%时,峰流速筛查对早期慢阻肺的敏感性大幅度升高。结论峰流速检测是慢阻肺良好的筛查方法。峰流速能否筛查出慢阻肺患者,取决于患者的肺功能(FEV1%pred)与症状严重程度(SGRQ)。峰流速筛查能早期发现慢阻肺患者,对气流受限程度重、急性加重风险高、需要药物治疗以缓解症状的患者尤为敏感。Objective To analyze the sensitivity of peak flow meter screening in different subgroups of chronic obstructive pulmonary disease （COPD）. Methods A total of 156 outpatients with COPD from Peking Union Medical Hospital from May 2013 to December 2014 were recruited in the study. Each patient＇s symptoms,history of exposure to risk factors, and the times of exacerbation in last year was recorded. All patients completed CAT, mMRC, the St George＇s Respiratory Questionnaire （SGRQ）,6 minutes walking test,spirometry, and peak expiratory flow （PEF） by peak flow meter. Results Using the cut-off of PEF% pred = 80% ,the PEF detected 120 COPD patients in 156 subjects. The predictive factors of abnormal PEF% pred in COPD was FEV, % pred and the total score of SGRQ （ P 〈 0. 05 ）. PEF screening could identify 76. 9% of COPD patients,30. 0% - 60. 0% of patients of less symptoms （ mMRC 〈 2 or CAT 〈 10 or SGRQ 〈 25） ,83.3% - 90. 9% of COPD patients with more symptoms （mMRC ≥2 or CAT ≥10 or SGRQ ≥ 25） ,27.7% of COPD patients with mild airflow limitation,68. 5% of COPD patients with moderate airflow limitation,83.3% of COPD patients with moderate to very severe airflow limitation. When grouped by GOLD combined assessment method,PEF screening could identify 35.2% of patients of group A,75.0% of patients of group B,and 95. 9% of patients of group C and D. The cut-off value of PEF% pred = 80% showed low sensitivity to early stage of COPD, but when using the cut-off value of PEF% pred = 95%, that sensitivity increased signifcantly. Conclusions Peak flow meter may be used as a tool to screen COPD. It can identify part of COPD patients especially for those patients with more symptoms, requiring regular treatment, with deteriorated pulmonary function and high risk of exacerbation.

关 键 词：慢性阻塞性肺疾病 峰流速仪 呼气峰流速 筛查 

分 类 号：R563.9[医药卫生—呼吸系统]