基于症状的COPD筛查问卷在社区老年人群COPD筛查中的应用  

Application of symptom-based questionnaire for identifying chronic obstructive pulmonary disease in screening chronic obstructive pulmonary disease among elderly residents

作　　者：金沿欣 高艳玲[1] 何艳[1] 吕俊[2] 郑丽华[3] 黄小明 Jin Yanxin;Gao Yanling;He Yan;Lyu Jun;Zheng Lihua;Huang Xiaoming(Department of Geriatrics,the Second People′s Hospital of Yibin,Yibin 644000,China;Department of Respiratory and Critical Care Medicine,the Second People′s Hospital of Yibin,Yibin 644000,China;Department of Clinical Nutrition,the Second People′s Hospital of Yibin,Yibin 644000,China;Department of Clinical Nutrition,Nanchong Central Hospital,Nanchong 637000,China)

机构地区：[1]宜宾市第二人民医院全科医学科,644000 [2]宜宾市第二人民医院呼吸与危重症医学科,644000 [3]宜宾市第二人民医院临床营养科,644000 [4]南充市中心医院临床营养科,637000

出　　处：《国际呼吸杂志》2021年第10期756-760,共5页International Journal of Respiration

基　　金：四川省卫生计生委课题(18PJ575);宜宾市科技局项目(2018YY008)。

摘　　要：目的对比基于症状的慢性阻塞性肺疾病(COPD)筛查问卷和慢性阻塞性肺疾病全球创议(GOLD)建议的"肺功能检查金标准"在社区老年人群COPD筛查中的应用。方法2020年1~12月采用分层抽样结合整群抽样的方法抽取宜宾市的社区老年居民712人,采用基于症状的COPD筛查问卷筛查COPD患病情况,对筛查阳性者用肺功能检测仪测定肺功能,参照GOLD 2017标准确诊COPD,比较两种方法在COPD诊断中的差别。结果(1)基于症状的COPD筛查问卷若以16.5分为界值,可疑COPD检出率16.7%;若以19.5分为界值,高危COPD检出率为10.3%。年龄越大、体质量指数越低和吸烟量越多者,可疑和高危COPD检出率越高(P<0.05)。(2)肺功能检查采用GOLD 2017标准确诊69例,患病率9.7%,不同年龄段、体质量指数和吸烟量老年人确诊COPD发病率差异均有统计学意义(P值均<0.05)。(3)以GOLD 2017标准为金标准,基于症状的COPD筛查问卷评分以16.5分和19.5分为截断值诊断COPD,其κ值分别为0.539和0.844,敏感度分别为81.2%和88.4%,特异度分别为90.2%和98.1%。结论基于症状的COPD筛查问卷适用于社区老年人群的COPD筛查,以19.5分为截断值更能反映个体的肺功能状况,一致性、敏感度和特异度均较高。Objective To compare the application of symptom-based questionnaire for identifying chronic obstructive pulmonary disease(COPD)and lung function test suggested by Global Initiative for Chronic Obstructive Lung Disease(GOLD)in screening COPD among elderly residents.Methods From January to December 2020,712 elderly residentshad been selected from Yibin by stratified sampling combined with cluster sampling,screened by symptom-based questionnaire for identifying COPD and diagnosed by lung function test respectively.Finally the consistency of two methods were compared in diagnosing COPD.Results(1)Screening by symptom-based questionnaire for identifying COPD score with 16.5 or 19.5,a total of 119 or 73 elderly residents was diagnosed as COPD with detection rate at 16.7%or 10.3%respectively,there were significant difference of positive rate with different age,body mass index and smoking level(all P<0.05).(2)Sixty-nine cases were confirmed as COPD by lung function test according to GOLD 2017 criterion with the prevalence at 9.7%,the significant differences were observed among elderly residents with different age,body mass index and smoking level(all P<0.05).(3)With GOLD 2017 criterion as the golden standard,symptom-based questionnaire for identifying COPD score of 16.5 or 19.5 was used as cut-off to diagnose COPD with kappa of 0.539 and 0.844,sensitivity of 81.2%and 88.4%,specificity of 90.2%and 98.1%,respectively.Conclusions Symptom-based questionnaire for identifying COPD is suitable for COPD screening among elderly residents.Taking 19.5 as cut-off value for diagnosing COPD can accurately reflect the lung function of individuals,with high consistency,sensitivity and specificity.

关 键 词：肺疾病 慢性阻塞性 基于症状的COPD筛查问卷 肺功能 一致性 

分 类 号：R563.9[医药卫生—呼吸系统]