阻塞性肺通气功能障碍患者脉冲振荡肺功能检测参数与常规肺通气功能检测指标的相关性  

Correlation of Impulse oscillometry system indices with conventional pulmonary function tests in patients with obstructive pulmonary ventilation dysfunction

作　　者：魏冰 张坤[1] 王正云[1] 付博华 黄晓敏 陈跃涛 赵建平[1] 王坚苗[1] 谢敏[1] 倪望[1] Wei Bing;Zhang Kun;Wang Zhengyun;Fu Bohua;Huang Xiaomin;Chen Yuetao;Zhao Jianping;Wang Jianmiao;Xie Min;Ni Wang(Department of Respiratory and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,National Health Commission Key Laboratory of Respiratory Diseases,Hubei Clinical Medical Research Center for Chronic Airway Diseases,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属同济医院呼吸与危重症医学科、国家卫生健康委员会呼吸疾病重点实验室、湖北省慢性气道疾病临床医学研究中心,武汉430000

出　　处：《中华内科杂志》2024年第11期1087-1095,共9页Chinese Journal of Internal Medicine

摘　　要：目的探究阻塞性肺通气功能障碍患者脉冲振荡肺功能检测参数与常规肺通气功能检测指标的相关性。方法选2020年1月1日至2022年12月31日在华中科技大学同济医学院附属同济医院呼吸与危重症医学科做肺通气功能检查的10 883例患者, 一秒率[第一秒用力呼气容积(FEV1)/用力肺活量(FVC)%]实测值占预计值百分比≥92%者为对照组(3 478例);一秒率实测值占预计值百分比<92%者为阻塞组(7 405例), 阻塞组分为轻度(3 938例)、中度(1 142例)、中重度(917例)、重度(737例)、极重度阻塞(671例)。两组患者行常规肺通气功能检查[FEV1、FVC、一秒率、用力呼气过程中肺部残余50%用力肺活量时呼气流速(MEF50%)、用力呼气过程中肺部残余25%用力肺活量时呼气流速(MEF25%)、用力呼气中期流速(MMEF)、用力呼气峰流速(PEF)]、脉冲振荡肺功能检测[呼吸总阻抗(Z5)、气道总阻力(R5)、外周弹性阻力(X5)、中心气道阻力(R20)、外周气道阻力(R5-R20)、外周阻力(Rp)、共振频率(Fresx)、电抗面积(Ax)]。比较两组不同程度受试者的指标差异, 并进行相关性分析, 对各指标的敏感度和特异度采用受试者操作特征(ROC)曲线分析。结果阻塞组患者FEV1占预计值百分比[80.10(54.95, 97.10)%]、一秒率[62.43(48.67, 67.02)%]、MEF50%[1.33(0.62, 1.97)L/s]、MEF25%[0.28(0.17, 0.41)L/s]、MMEF[0.85(0.43, 1.29)L/s]、PEF[5.64(3.73, 7.50)L/s]低于对照组, 差异有统计学意义(P<0.05);阻塞组中不同程度阻塞者间差异均有统计学意义(P<0.05)。阻塞组患者Z5[0.42(0.33, 0.55)kPa·L^(-1)·s^(-1)]、Rp[0.25(0.20, 0.45)kPa·L^(-1)·s^(-1)]、R5[0.39(0.31, 0.49)kPa·L^(-1)·s^(-1)]、R20[0.28(0.24, 0.34)kPa·L^(-1)·s^(-1)]、R5-R20[0.09(0.05, 0.17)kPa·L^(-1)·s^(-1)]、Frex[16.32(13.07, 20.84)Hz]、Ax[0.67(0.28, 1.64)]高于对照组, X5[-0.14(-0.23, -0.10)kPa·L^(-1)·s^(-1)]低于对照组, 差异有统计学意义(P<0.05);阻塞组中不同程度阻塞间Z5、Rp、X5�Objective:To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function.Methods:The pulmonary ventilation function data of 10883 patients from January 1,2020 to December 31,2022 at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were included.The one-second rate[ratio of forced expiratory volume in the first second(FEV 1)to forced vital capacity(FVC)]measured as a percentage of the predicted value was≥92%for the control group(n=3478)and<92%for the pulmonary obstruction group(n=7405).The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction:mild group(n=3938),moderate group(n=1142),oderate-severe group(n=917),severe group(n=737),and extremely severe group(n=671).Conventional pulmonary ventilatory function FVC,FEV 1,one-second rate,and forced expired flow at 50%of FVC(MEF50%),forced expired flow at 75%FVC(MEF25%),maximal mid-expiratory flow(MMEF),peak expiratory flow(PEF),and pulsed oscillation pulmonary function test were detected in both groups of patients.Impedance at 5 Hz(Z5)means total respiratory resistance,resistance at 5 Hz(R5)means total airway resistance,reactance at 5 Hz(X5)indicates the elastic recoil of the peripheral airways,and resistance at 20 Hz(R20)represents resistance of the central airways.R5-R20 reflects resistance in the small airways.Additionally,peripheral resistance(Rp),respiratory resonance frequency(Frex),and area under the reactance curve(Ax)were also measured.Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed.Results:Pulmonary function force expiratory volume in the first second as a percentage of predicted value(FEV 1%Pre)[80.10(54.95,97.10)%],one-second rate[62.43(48.67,67.02)%],MEF50%[1.33(0.62,1.97)L/s],MEF25%[0.28(0.17,0.41)L/s],MMEF[0.85(0.43,1.29)L/s],and PEF[

关 键 词：脉冲振荡检测 肺通气功能检测 阻塞性肺通气功能障碍 

分 类 号：R563.9[医药卫生—呼吸系统]