FEV_1/FEV_6筛检中老年慢性阻塞性肺疾病患者的可行性研究和截断值探讨  

The feasibility study and the truncation value of FEV_1/FEV_6 as a standard for the diagnostic screening of the middle-aged and elderly patients with chronic obstructive pulmonary disease

作　　者：蔡梓滔 马子奇 谷红丽[2] 莫少门 庄怡哲 钟碧华 何太平[3] 史亚鹏 姚卫民 

机构地区：[1]广东医科大学附属医院呼吸内科,广东湛江524001 [2]湖南省郴州市第一人民医院超声医学中心,湖南郴州423000 [3]广东医科大学营养与食品卫生学教研室,广东湛江524023

出　　处：《广东医学院学报》2016年第6期553-557,共5页Journal of Guangdong Medical College

基　　金：广东省科技计划项目(No.2016ZC0178)

摘　　要：目的评价第一秒用力呼气容积(FEV_1)与第六秒用力呼气容积(FEV_6)的比值(FEV_1/FEV_6)能否用于筛检中老年慢性阻塞性肺疾病(COPD)患者,确定粤西地区40岁以上人群的最佳诊断截断值,以期对我国社区筛检COPD患者提供参考。方法 2015年7-9月在湛江地区随机抽取40岁以上居民进行肺功能检测,对FEV_6与用力肺活量(FVC)、FEV_1/FVC与FEV_1/FEV_6进行相关性分析,以吸入支气管扩张剂后FEV_1/FVC<70%为金标准,应用受试者工作特征曲线(ROC),求出并探讨FEV_1/FEV_6最佳诊断临界值。结果共有863名符合质控要求的参与者,其中男性303名,女性560名。FEV_6与FVC呈高度正相关(r=0.988,P<0.01),FEV_1/FEV_6与FEV_1/FVC呈高度正相关(r=0.974,P<0.01)。ROC曲线下面积为0.980(P<0.01)。FEV_1/FEV_6的最佳截断值为75%,此时约登指数为84.2%,符合率为94.2%,敏感度为89.6%,特异度为94.6%。结论用支气管舒张后FEV_1/FEV_6做指标筛检中老年COPD患者是可行的,推荐用FEV_1/FEV_6<75%作为筛检的标准。Objective To evaluate whether the forced expiratory volume in one second（FEV1）/forced expiratory volume in six second （FEV6） can be used for screening the middle-aged and elderly patients with chronic obstructive pulmonary disease （COPD） and to determine its best fixed cut-off points for the adults over 40 years old in the west of Guangdong Province so as to provide a reference for the screening of the patients with COPD in China community. Methods The residents aged 40 years or more were invited to participate in the pulmonary function test in Zhanjiang from July 2015 to September 2015. The correlation between the FEV6 and forced vital capacity （FVC）, FEV1/FVC and FEV1/FEV6 were analyzed. Receiver-operator characteristic curves （ROC） were used to determine the best fixed cut-off points by using the postbronchodilator FEVI/FVC〈70% as the gold standard to screen COPD patients. Results A total of 863 participants including 303 men and 560 women met quality control requirements. The FEV6 and FVC were highly positive correlated （r=0.988, P〈0.01）, FEV1/FEV6 and FEV1/FVC were highly positive correlated （r=0.974, P〈0.01）. The area under curve is 0.980 （P〈0.01）. The best fixed cut-off point is 75%. The Youden＇s index and coincidence rate were 84.2% and 94.2%, respectively. The sensitivity and specificity were 89.6% and 94.6%, respectively. Oonclusion It＇s feasible to use the postbronchodilator FEV1/FEV6 to screen the middle-aged and elderly patients with COPD in community and 75% is recommended as the best fixed cut-off points.

关 键 词：第一秒用力呼气容积 第六秒用力呼气容积 慢性阻塞性肺疾病 肺功能检查 

分 类 号：R563[医药卫生—呼吸系统]