Page 82 - 中国全科医学2022-01

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·207·

4. Department of General Practice，Qinhong Community Health Service Center，Nanjing 211101，China
*
Corresponding author：SHAO Hongtao，Chief physician；E-mail：shaohongtao111@126.com
【Abstract】 Background Chronic obstructive pulmonary disease （COPD） is a common chronic disease of the
respiratory tract，and lung function is necessary for the diagnosis of COPD. However，conventional pulmonary function meters are
not suitable for a large number of physical examinations in the community. In recent years，it is recommended to use spirometry for
COPD screening and management both at home and abroad. However，there is still a lack of relevant data on its consistency and
effectiveness with conventional lung function. Objective To explore the value of handheld COPD-6 spirometry for early COPD
detection in high risk elderly population in community. Methods From January 2018 to December 2019 at Dongshan Community
Health Service Center，Jiangning District，Nanjing City，a free physical examination was performed on the elder population over
60 years who had high risk factors of COPD. Handheld COPD-6 spirometry was performed pre- and post-bronchodilator，the
forced expiratory volume in one second （FEV 1 ），the forced expiratory volume in one second as a percentage of the predicted
value （FEV 1 %prep），the forced expiratory volume in six second （FEV 6 ），the percentage of forced expiratory volume
in six second to the predicted value （FEV 6 %prep），and the value of FEV 1 /FEV 6 were evaluated and recorded. With FEV 1
/FEV 6 <80% as the initial screening positive pre-bronchodilator，retests were performed both with handheld COPD-6 spirometry
and confirmatory spirometry after inhaling bronchodilator. Using FEV 1 /Forced vital capacity （FVC） <70% as the gold standard
by confirmatory spirometry，receiver-operator characteristic（ROC）curve analysis was used to obtain the best diagnostic
threshold of FEV 1 /FEV 6 . Sensitivity，specificity，positive predictive value，and negative predictive value were used to evaluate
the diagnostic value of the handheld COPD-6 spirometer. Results Out of the 382 participants，COPD was confirmed in 75
according to FEV 1 /FVC<70% post-bronchodilator. There was no statistically significant difference between FEV 1 %pred pre- and
post-bronchodilator by handheld COPD-6 spirometry （t=-0.971，P=0.703）；There was no statistically significant difference
among FEV 1 %pred in two tests （t=-2.352，-1.429；P=0.396，0.058）. The FEV 1 %pred detected by handheld COPD-6
spirometry post-bronchodilation was positively correlated with confirmatory spirometry （r=0.969，P<0.05）. Compared with
FVC%pred and FEV 6 %pred post-bronchodilation，the difference was statistically significant （t=-3.170，P=0.005）；and the
FEV 6 %pred was positively correlated with the FVC%pred （r=0.653，P<0.05）. There was no statistically significant difference
between FEV 1 /FEV 6 and FEV 1 /FVC post-bronchodilation （t=1.735，P=0.084）；and there was substantial agreement between
the two diagnostic （r=0.871，P<0.05）. The FEV 1 /FEV 6 cut-off with the greatest sum of sensitivity and specificity was 71% pre-
bronchodilator，the sensitivity，specificity，positive and negative predictive values were 80.0%，79.2%，90.6% and 48.5%
respectively. The greatest sum of sensitivity and specificity was 75% post-bronchodilator，the sensitivity，specificity，positive
and negative predictive values were 80.0%，98.8%，98.4% and 58.3% respectively. Conclusion It is feasible to use FEV 1
/FEV 6 as an indicator to screen COPD patients in elderly high-risk populations. It is recommended to use FEV 1 /FEV 6 <71% before
bronchodilation and FEV 1 /FEV 6 <75% after diastole as the screening criteria.
【Key words】 Chronic obstructive pulmonary disease；Handheld COPD-6 spirometry；Forced expiratory volume in
one second；Forced expiratory volume in six second；Forced vital capacity；Diagnostic value；Sensitivity；Specificity

慢 性 阻 塞 性 肺 疾 病（chronic obstructive pulmonary 分析使用支气管舒张剂前后 FEV 1 / 第 6 秒用力呼气末
disease，COPD）是一种常见的呼吸系统慢性炎性疾病， 容积（FEV 6 ）比值（FEV 1 /FEV 6 ）与常规肺功能检测
目前已经成为严重的公共卫生问题，我国 40 岁以上居 中 FEV 1 /FVC 的一致性，进而探讨 FEV 1 /FEV 6 能否替代
民 COPD 患病率高达 8.20%，并且有逐年升高趋势 ［1］ 。 FEV 1 /FVC 作为初筛 COPD 的依据，并确定最佳截断值，
目前肺功能检测是公认确诊 COPD 的必要条件，也是评 以期对社区筛查 COPD 患者提供参考。
估病情严重程度的依据。现有筛查 COPD 患者的指标主 1 对象与方法
要是支气管舒张后第 1 秒用力呼气末容积（FEV 1 ）/ 用 1.1 研究对象 选取 2018 年 1 月至 2019 年 12 月在南
力肺活量（FVC）比值（FEV 1 /FVC）<70% ［2-3］ 。但是 京市江宁区东山街道社区卫生服务中心进行免费体检的
常规肺功能仪因其操作相对复杂、设备笨重、不可移动、 60 岁及以上且具有 COPD 高危因素人群为研究对象。
检查费用高等原因无法用于社区大量体检 ［4］ 。近年来 纳入标准：（1）神志清楚，能配合肺功能测定；（2）
国内外相关研究聚焦于通过便携式 COPD-6 肺量计进行 包括以下 COPD 高危因素之一：吸烟史（不论目前戒烟
COPD 筛查和管理 ［5-6］ 。但其与常规肺功能仪的一致性 与否），有慢性咳嗽、咳痰、气喘症状，有粉尘等职业
和有效性尚缺乏相关数据支持。 接触史，有 COPD、哮喘家族史；（3）对本研究知情
本研究使用便携式 COPD-6 肺量计对社区 60 岁 同意。排除标准：（1）合并严重心脑血管疾病、精神
以上且具有 COPD 高危因素的人群进行肺功能检查， 障碍无法配合检查者；（2）近期接受过胸部或腹部手