30秒坐立试验联合慢性阻塞性肺疾病患者自我评估测试评分对运动性低氧的预测价值及临床应用研究  

Predictive Value of the Oxygen Desaturation Induced by the 30-second Sit-to-stand-test combined with COPD Patient Self-assessment Test in Exercise-induced Hypoxemia and Its Clinical Application

作　　者：杨天祎 司徒炫明 曲木诗玮 王思远[1] 江山 杨汀[3] YANG Tianyi;SITU Xuanming;QUMU Shiwei;WANG Siyuan;JIANG Shan;YANG Ting(Department of Rehabilitation Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Pain and Rehabilitation Center,Beijing Jishuitan Hospital Zhongshan Orthopedic Hospital,Zhongshan 528455,China;Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital/National Center for Respiratory Medicine/Institute of Respiratory Medicine,Chinese Academy of Medical Sciences/National Clinical Research Center for Respiratory Disease/WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention,Beijing 100029,China)

机构地区：[1]中日友好医院康复医学科,北京市100029 [2]北京积水潭医院中山骨科医院疼痛康复中心,广东省中山市528455 [3]中日友好医院呼吸中心呼吸与危重症医学科国家呼吸医学中心中国医学科学院呼吸病学研究院国家呼吸疾病临床医学研究中心世界卫生组织戒烟与呼吸疾病预防合作中心,北京市100029

出　　处：《中国全科医学》2024年第33期4119-4124,共6页Chinese General Practice

基　　金：中国医学科学院医学与健康科技创新工程2021年重大协同创新项目(2021-12M-1-049)。

摘　　要：背景慢性阻塞性肺疾病(COPD)是老年患者常见呼吸系统疾病之一,活动时外周经皮血氧饱和度(SpO_(2))下降是普遍存在的现象,与疾病预后存在相关性,目前诱导运动性低氧(EID)的评估结论不一。目的探究适合社区及居家COPD患者诱导EID的方法。方法回顾性选择中日友好医院2021年1月—2023年8月收治的76例COPD稳定期患者为研究对象。收集六分钟步行测试(6MWT)中静息SpO_(2)与运动中最低SpO_(2)(ΔSpO_(2)),以ΔSpO_(2)≥4%为EID判定标准。根据有无EID分为非EID组和EID组,比较两组的肺功能指标、30秒坐立试验(30s STST)ΔSpO_(2)、COPD患者自我评估测试(CAT)评分。探究EID与30s STSTΔSpO_(2)、CAT评分的关系;采用受试者工作特征(ROC)曲线分析30s STSTΔSpO_(2)、CAT评分及二者联合对EID的预测价值。结果非EID组(n=29)与EID组(n=47)中30s STSTΔSpO_(2)、CAT评分比较,差异有统计学意义(P<0.05);30s STSTΔSpO_(2)预测EID截断值为2%,灵敏度为59.6%,特异度为82.8%,ROC曲线下面积(AUC)为0.730(95%CI=0.614~0.846,P<0.05);CAT评分预测EID截断值为13分,灵敏度为48.9%,特异度为79.3%,AUC为0.712(95%CI=0.596~0.828,P<0.05);30s STSTΔSpO_(2)联合CAT评分预测EID的截断值为0.593,灵敏度为70.2%,特异度为72.4%,AUC为0.765(95%CI=0.659~0.871,P<0.001)。结论30s STST诱发SpO_(2)≥2%、CAT评分≥13分,需警惕EID的发生可能;30s STST、CAT评分可以成为社区及居家预测稳定期COPD患者诱导EID的测评方法。Background Chronic obstructive pulmonary disease(COPD) is one of the most common respiratory diseases in elderly patients,and a decrease in oxygen saturation during activity is a common phenomenon correlated with the prognosis.Current assessment of exercise-induced hypoxia(EID) has yielded controversial results.Objective To explore methods suitable for inducing EID in community and home-based COPD patients.Methods This was a retrospective study involving 76 patients with stable COPD admitted to China-Japan Friendship Hospital from January 2021 to August 2023.Resting oxygen saturation and the lowest oxygen saturation during exercise( ΔSpO_(2)) in the six-minute walk test 6MWT) were recorded.Based on the criterion of ΔSpO_(2)≥4%for the diagnosis of EID,patients were assigned into non-EID group and EID group.Pulmonary function indicators,ΔSpO_(2) during 30-second sit-to-stand-test(30s STST),and COPD Assessment Test(CAT) were compared between the two groups.The correlation of EID with ΔSpO_(2) of 30s STST and CAT scores was identified.The predictive value of ΔSpO_(2) of 30s STST,CAT score,and ΔSpO_(2) of 30s STST combined with CAT score in predicting EID was analyzed using the receiver operating characteristic(ROC) curves.Results There were significant differences in the ΔSpO_(2) of 30s STST and CAT score between non-EID group and EID group.The cut-off value of ΔSpO_(2) of 30s STST in predicting EID was 2%,with the sensitivity,specificity and area under the curve(AUC) of 59.6%,82.8%,0.730(95%CI=0.614-0.846,P<0.05),respectively.The cut-off value of CAT scores in predicting EID was 13,with the sensitivity,specificity and AUC of 48.9%,79.3%,0.712(95%CI=0.596-0.828,P<0.05),respectively.The cut-off value of ΔSpO_(2) of 30s STST combined with CAT scores in predicting EID was 0.593,with the sensitivity,specificity and AUC of 70.2%,72.4%and 0.765(95%CI=0.659-0.871,P<0.001),respectively.Conclusion ΔSpO_(2) of 30s STST≥2% and CAT score≥13 points alarm the development of EID.The 30s STST and CAT can be used as c

关 键 词：肺疾病 慢性阻塞性 坐立试验 低氧血症 运动性低氧 居家康复 预测 

分 类 号：R563.9[医药卫生—呼吸系统]