F-V曲线下降支夹角在COPD患者诊治中的综合评估价值  

The clinical value of the collapse angle of F-V curve in the diagnosis and treatment of COPD patients

作　　者：李萍 王诗绮 倪艾珺 陈幼花 丁文秋 宋玮 孙培莉 LI Ping;WANG Shiqi;NI Aijun;CHEN Youhua;DING Wenqiu;SONG Wei;SUN Peili(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Critical Care Medicine,Nanjing Gaochun People’s Hospital,Nanjing 211306;Department of Respiratory and Critical Care Medicine,Changzhou Maternal and Child Health Hospital,Changzhou 213023,China)

机构地区：[1]南京医科大学第一附属医院呼吸与危重症医学科,江苏南京210029 [2]南京市高淳人民医院重症医学科,江苏南京211306 [3]常州市妇幼保健院呼吸与危重症医学科,江苏常州213023

出　　处：《南京医科大学学报（自然科学版）》2024年第10期1369-1376,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2018YFC1311900):呼吸系统疾病临床研究大数据与生物样本库平台。

摘　　要：目的:研究流量-容积(flow-volume,F-V)曲线下降支夹角在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者临床表型及病情严重度评估中的临床价值。方法:选取2021年12月—2022年12月在南京医科大学第一附属医院进行肺功能检查的患者共101例,其中,存在F-V曲线下降支夹角的稳定期COPD患者(夹角组)33例,与夹角组第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second as a percentage of predicted value,FEV1%pred)匹配的无下降支夹角的稳定期COPD患者(无夹角组)38例,既往无心肺疾病,且肺功能检测正常的受试者(对照组)30例。收集并比较各组患者基本资料、临床症状评分[COPD自我评估测试(COPD assessment test,CAT)、改良版英国医学研究委员会呼吸困难问卷(modified medical research council dyspnoea scale,mMRC)]、肺功能参数和运动后指脉氧参数。采用多因素Logistic回归分析F-V曲线下降支夹角的相关因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析F-V曲线下降支夹角对COPD随访1年内急性加重的预测价值。结果:夹角组肺功能受损程度严重,第1秒用力呼气容积(forced expiratory volume in the first second,FEV1)和用力肺活量(forced vital capacity,FVC)分别为0.91±0.24、2.11±0.63;夹角组CAT评分、mMRC评分、ΔSpO_(2)高于无夹角组及对照组,步行运动后SpO_(2)L低于无夹角组及对照组,差异有统计学意义(P<0.05);夹角组CAT评分≥12分、m MRC评分≥2分、ΔSpO_(2)≥13%是F-V曲线下降支更易出现夹角的主要相关因素;F-V曲线下降支夹角预测重度稳定期COPD急性加重的曲线下面积为0.777,当角度<129.1°时其预测灵敏度、特异度均为最佳,分别为72.73%、67.35%。结论:F-V曲线呈现下降支夹角的COPD患者其肺功能常严重受损,且更易发生活动后低氧血症和急性加重。因此,COPD肺功能报告中应关注F-V曲线下降支是否存�Objective:To study the clinical value of the collapse angle of flow-volume(F-V)curve in assessment of clinical phenotype and severity of chronic obstructive pulmonary disease(COPD)patients.Methods:A total of 101 subjects who underwent pulmonary function tests from December 2021 to December 2022 at the First Affiliated Hospital of Nanjing Medical University were selected for this study.Subjects in the angle group were 33 stable COPD patients with collapse angle of F-V curve.The non-angle group including 38 cases of stable COPD patients without collapse angle,who matched with the angle group in forced expiratory volume in the first second as a percentage of predicted value(FEV1%pred).The control group including 30 subjects without previous cardiopulmonary disease and had normal lung function.Basic information,clinical symptom scores(CAT score,mMRC score),pulmonary function parameters and daily exercise finger pulse oxygen parameters were collected and compared among the groups.Multifactorial logistic regression was used to analyze the factors associated with the collapse angle of F-V curve.The predictive value of the collapse angle of F-V curve for acute exacerbation of COPD within one year of follow-up was analyzed by receiver operating characteristic(ROC)curve.Results:Pulmonary function was severely impaired in the angle group,with FEV1 and forced vital capacity(FVC)of 0.91±0.24 and 2.11±0.63,respectively.CAT score,mMRC score,andΔSpO_(2)of the angle group were higher than those of the non-angle group and the control group.SpO_(2)L of the angle group after walking exercise was lower than that of the non-angle group and the control group(P<0.05).CAT score≥12,mMRC score≥2,andΔSpO_(2)≥13%were main related factors of the emergence of the collapse angle of F-V curve.The area under the ROC curve of the collapse angle of F-V curve for predicting the acute exacerbation of COPD was 0.777.The sensitivity and specificity of prediction were the best when the angle was<129.1°,which were 72.73%and 67.35%,respectively

关 键 词：慢性阻塞性肺疾病 最大呼气流量-容积曲线 夹角 肺功能检查 氧饱和度下降 

分 类 号：R563[医药卫生—呼吸系统]