成人呼吸阻抗参数检测气流阻塞的诊断准确性

S. De
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摘要

目的:本研究旨在评价阻抗参数检测成人气流阻塞的诊断准确性和气流阻塞的严重程度。方法:采用强迫振荡法测定连续299例成人(男性186例)的肺活量测定参数(1 s用力呼气量[FEV1]、用力肺活量[FVC]、FEV1/FVC、FVC3/FVC、FEF25-75)和呼吸阻抗参数(R5、R19、R5-19、X5)。采用Spearman相关系数(ρ)评价阻抗参数与肺活量测定指标的相关性。采用曲线下面积(AUC)评价呼吸阻抗参数的诊断准确性。结果:研究人群平均年龄为54.1±12.3岁,肺活量测定出现气流阻塞99例(33%)(FEV1/FVC < 0.70)。各肺活量指标(预测百分比)与R5、R19、R5-19呈弱负相关,与X5呈弱正相关。预测R5 >142%和X5 >136%的最大AUC(0.75),识别气流阻塞的灵敏度高达56%,特异性高达86%。阻抗参数与气流阻塞程度的一致性较低。结论:呼吸阻抗参数对诊断成人气流阻塞及阻塞程度的敏感性不足。因此,阻抗参数在诊断阻塞性肺功能时不能代替肺活量测定法。
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Diagnostic accuracy of respiratory impedance parameters to detect airflow obstruction in adults
OBJECTIVE: The present study was aimed to evaluate the diagnostic accuracy of impedance parameters to detect airflow obstruction and the severity of airflow obstruction in adults. METHODS: The spirometry parameters (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], FEV1/FVC, FVC3/FVC, and FEF25-75) and respiratory impedance parameters (R5, R19, R5-19, and X5) measured by forced oscillation technique of consecutive 299 adults (male: 186) were included in the present analysis. The Spearman correlation coefficient (ρ) was used to assess the correlations of impedance parameters with spirometry indices. The area under the curve (AUC) was used to assess respiratory impedance parameters' diagnostic accuracy. RESULTS: The mean age of the study population was 54.1 ± 12.3 years, and 99 individuals (33%) had airflow obstruction (FEV1/FVC < 0.70) in spirometry. All spirometry indices (% of predicted) showed a weak negative correlation with R5, R19, R5-19, and weak positive correlation with X5. The R5 >142% predicted and X5 >136% predicted had the maximum AUC (0.75) with a sensitivity of up to 56% and specificity up to 86% to identify airflow obstruction. The impedance parameters showed low concordance with the severity of airflow obstruction. CONCLUSION: Respiratory impedance parameters had insufficient sensitivity to diagnose airflow obstruction and the severity of obstruction in adults. Thus, impedance parameters cannot a substitute for spirometry in diagnosing obstructive lung function.
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