脉冲振荡技术在慢性阻塞性肺疾病中的诊断价值  

Diagnostic value of impulse oscillometry system in chronic obstructive pulmonary disease:a retrospective study

作　　者：字楷 高丽娟 文富强[1] ZI Kai;GAO Lijuan;WEN Fuqiang(Department of Respiratory and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610004,Sichuan,China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《上海医学》2024年第10期603-609,共7页Shanghai Medical Journal

基　　金：国家自然科学基金(82300050);1.3.5四川大学华西医院卓越学科项目(ZYGD23009)。

摘　　要：目的探究脉冲振荡技术(IOS)在慢性阻塞性肺疾病(以下简称慢阻肺病)患者诊断和检测气流受限严重程度方面的潜在价值。方法本研究回顾性纳入2014年1月1日至6月30日期间在四川大学华西医院、成都大学附属医院和西南医科大学附属成都363医院就诊的40岁及以上患者,分为慢阻肺病组和对照组。采用t检验或Mann-Whitney检验比较两组患者的基线资料、肺量计法和IOS检测结果。采用方差分析比较不同严重程度慢阻肺病患者之间IOS参数的差异,采用Spearman相关性检验分析肺量计参数和IOS参数的相关性,并通过ROC曲线评估IOS参数独立诊断慢阻肺病的灵敏度和特异度。结果与对照组相比,慢阻肺病组患者5 Hz时的呼吸阻抗(Z5)、呼吸电阻(R5)、R5与20 Hz时的呼吸电阻(R20)的差值(R5-R20)、共振频率(Fres)和外周阻力(Rp)等IOS参数显著升高,而5 Hz时的电抗(X5)显著降低,差异均有统计学意义(P值均<0.0001)。在慢阻肺病患者中,慢性阻塞性肺疾病全球倡议(GOLD)分级越高,IOS参数Z5、Fres、R5-R20和Rp升高(P值均<0.0001),X5则下降(P<0.05)。Spearman相关性分析结果显示,IOS参数包括Z5、Fres、R5-R20和Rp均与FEV_(1)/FVC(Z5:ρ=-0.31,Fres:ρ=-0.46,R5-R20:ρ=-0.47,Rp:ρ=-0.39,P值均<0.0001)、FEV_(1%)(Z5:ρ=-0.30,Fres:ρ=-0.47,R5-R20:ρ=-0.40,Rp:ρ=-0.40,P值均<0.0001)和MMEF_(25%~75%)(Z5:ρ=-0.42,Fres:ρ=-0.55,R5-R20:ρ=-0.51,Rp:ρ=-0.50,P值均<0.0001)呈显著负相关。X5则与FEV_(1)/FVC(ρ=0.40,P<0.05)、FEV_(1%)(ρ=0.39,P<0.05)和MMEF_(25%~75%)(ρ=0.50,P<0.05)呈显著正相关。IOS参数Z5、Fres、R5-R20、Rp和X5诊断慢阻肺病的AUC均大于0.500(P值均<0.0001),其中Fres(AUC为0.7475,最佳截断值为20.34[cmH 2O/(L·s)],灵敏度为0.64、特异度为0.75)诊断慢阻肺病的AUC值最高。结论IOS参数在慢阻肺病患者和对照组之间存在显著差异,同时与肺量计参数具有显著的相关性,且都能有效诊断慢阻肺病,提示IOS对慢阻肺�Objective To investigate the potential value of the impulse oscillometry system(IOS)in diagnosing and detecting the severity of airflow limitation in patients with chronic obstructive pulmonary disease(COPD).Methods Patients aged 40 years and older who attended West China Hospital of Sichuan University,Affiliated Hospital of Chengdu University,and Chengdu 363 Hospital of Southwest Medical University between January 1 and June 30,2014 were included in this retrospective study and divided into the COPD group and control group.The baseline data and test results of spirometry and IOS were compared between the two groups by the t-test or Mann-Whitney test.IOS parameters were compared among patients with COPD of different severity by analysis of variance(ANOVA).The correlation between spirometry parameters and IOS parameters were investigated by Spearman correlation test,and ROC curves were used to assess the sensitivity and specificity of IOS parameters for the diagnosis of COPD.Results IOS parameters such as Z5,R5,R5-R20,Fres and Rp in the COPD group were significantly higher than those in the control group,while X5 in the COPD group was significantly lower than that in the control group(all P<0.0001).In COPD patients,the higher the Global Initiative for Chronic Obstructive Lung Disease(GOLD)classification,the higher the Z5,Fres,R5-R20,and Rp(all P<0.0001),and the lower the X5(P<0.05).Spearman’s correlation analysis showed that the Z5,Fres,R5-R20,and Rp were significantly negatively correlated with FEV_(1)/FVC(Z5:ρ=-0.31,Fres:ρ=-0.46,R5-R20:ρ=-0.47,Rp:ρ=-0.39,all P<0.0001),FEV_(1%)(Z5:ρ=-0.30,Fres:ρ=-0.47,R5-R20:ρ=-0.40,Rp:ρ=-0.40,all P<0.0001),and MMEF_(25%~75%)(Z5:ρ=-0.42,Fres:ρ=-0.55,R5-R20:ρ=-0.51,Rp:ρ=-0.50,all P<0.0001);X5 was significantly positively correlated with FEV_(1)/FVC(ρ=0.40,P<0.05),FEV_(1%)(ρ=0.39,P<0.05),and MMEF_(25%~75%)(ρ=0.50,P<0.05).The AUC of Z5,Fres,R5-R20,Rp,and X5 for the diagnosis of COPD were all greater than 0.500(all P<0.0001),and the largest AUC for the diagnosis of C

关 键 词：肺疾病 慢性阻塞性 脉冲振荡技术 多中心研究 回顾性研究 肺量测定法 

分 类 号：R563.9[医药卫生—呼吸系统]