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目的探讨峰流速仪呼气峰流速(PEF)检测对不同程度慢性阻塞性肺疾病(简称慢阻肺)人群筛查的敏感性。方法选取2013年5月至2014年12月在北京协和医院呼吸内科门诊确诊的156例慢阻肺患者,采集患者病史、症状、危险因素暴露史、近1年急性加重次数和合并症等资料,并进行6分钟步行测试,测评慢阻肺评估测试(CAT)、改良英国医学研究委员会呼吸问卷(m MRC)和圣乔治呼吸问卷(SGRQ)。同时采用肺功能仪测量通气功能以及峰流速仪测量PEF。结果以PEF占预计值百分比(PEF%pred)=80%为截断值,156例患者中筛查出120例(76.9%),36例被判定为漏诊人群。影响慢阻肺人群能否被峰流速仪筛查出的因素为FEV1%pred与SGRQ总分(P<0.01)。PEF筛查慢阻肺患者的整体敏感性为76.9%,对轻度气流受限患者的敏感性为27.7%,对中度气流受限患者的敏感性为68.5%,对重度~极重度气流受限患者的敏感性为98.5%,对中度~极重度气流受限患者的敏感性为83.3%;对CAT<10患者的敏感性为48.3%,对m MRC<2患者的敏感性为60.0%,对SGRQ<25患者的敏感性为30.0%;对CAT≥10患者的敏感性为87.5%,对m MRC≥2患者的敏感性为90.9%,对SGRQ≥25患者的敏感性为90.0%;对A级患者的敏感性为35.2%,对B级患者的敏感性为75.0%,对慢阻肺高危人群(C~D级)的敏感性为95.9%。以80%为截断值,峰流速筛查对早期慢阻肺患者(肺功能GOLD 1级、症状轻、慢阻肺综合评估A级)的敏感性较低;当截断值调整为95%时,峰流速筛查对早期慢阻肺的敏感性大幅度升高。结论峰流速检测是慢阻肺良好的筛查方法。峰流速能否筛查出慢阻肺患者,取决于患者的肺功能(FEV1%pred)与症状严重程度(SGRQ)。峰流速筛查能早期发现慢阻肺患者,对气流受限程度重、急性加重风险高、需要药物治疗以缓解症状的患者尤为敏感。
Objective To investigate the sensitivity of peak flow velocity meter (PEF) to screening patients with chronic obstructive pulmonary disease (COPD) of different degrees. Methods From May 2013 to December 2014, 156 patients with chronic obstructive pulmonary disease diagnosed in Peking Union Medical College Respiratory Clinic were enrolled. Their medical history, symptoms, exposure history of risk factors, number of acute exacerbations and comorbidity in the past year were collected. A 6-minute walking test, a CAT assessment, a modified MRM Respiratory Questionnaire (m MRC) and a St. George’s Respiratory Questionnaire (SGRQ) were performed. At the same time using the lung function measurement ventilation function and peak velocity meter measurement PEF. Results The PEF% pred = 80% was used as the cutoff value. Among 156 patients, 120 (76.9%) were screened and 36 were diagnosed as missed. The factors influencing whether COPD patients could be screened by peak-current velocity were FEV1% pred and SGRQ scores (P <0.01). The overall sensitivity of PEF screening for COPD patients was 76.9%, sensitivity to light airflow restricted patients was 27.7%, sensitivity to moderate airflow restricted patients was 68.5%, and for severe to severe airflow affected Sensitivity in patients with limited to 98.5%, moderate to very severe airflow restricted in patients with sensitivity was 83.3%; CAT <10 in patients with sensitivity was 48.3%, m MRC <2 in patients with sensitivity was 60.0% , 30.0% for patients with SGRQ <25, 87.5% for patients with CAT≥10, 90.9% for patients with MRC≥2, and 90.0% for patients with SGRQ≥25; Sensitivity to Class A patients was 35.2%, to Class B patients was 75.0%, and to C-D high-risk populations was 95.9%. At a cutoff of 80%, the peak flow rate was less sensitive to early COPD patients (Level 1 of lung function GOLD, symptom light, COPD A); when the cutoff value was adjusted to 95% Peak flow velocity screening for early COPD increased significantly. Conclusion Peak flow velocity is a good screening method for COPD. Peak-flow screening for patients with COPD hinders lung function (FEV1% pred) and severity of symptoms (SGRQ). Peak-flow screening Early detection of COPD patients is particularly sensitive to patients with limited airflow restriction, a high risk of exacerbation, and medication requiring medication to relieve symptoms.