适宜国人BMI分级的慢性阻塞性肺疾病筛查问卷的检验与评价

目的 对适宜中国人BMI分级的慢性阻塞性肺疾病（COPD）社区筛查问卷效度做检验与评价.方法 选取惠州市第一人民医院肺功能室40岁以上行肺功能检查者（共629人）,以支气管舒张试验后第一秒钟用力呼气容积与用力肺活量比值（FEV1/FVC）〈70%作为诊断COPD的金标准,共收集254例COPD患者和375 名非COPD人员.两组研究对象均填写国际呼吸道组织推荐的COPD筛查问卷.将获得的数据用适宜中国人BMI分级的筛查评分与问卷评分标准对比,以检验该筛查问卷在国人中应用的效果.结果 修改原国际呼吸道组织推荐的COPD筛查问卷BMI的分级后,经受试者工作特征（ROC）分析,其ROC曲线下面积较原筛查问卷提高（分别为0.916 与0.901,P〈0.01）.选取17分为最佳截断点,问卷的灵敏度、特异度、阳性似然比、阴性似然比、正确诊断指数、阳性预测值、阴性预测值等分别为88.2%、77.3%、3.89、0.15、0.655、72.5%、90.6%.结论 根据中国人BMI分级调整后的COPD筛查问卷对COPD的区分效度好,其筛查能力提高,最佳截断点仍可选择17分,适合在我国社区进一步推广应用.

Survey and evaluation of chronic obstructive pulmonary disease screening questionnaire suitable to the Chinese BMI classification

Objective To evaluate the validity of a questionnaire for Chinese body mass index （BMI） classification of chronic obstructive puhnonary disease （COPD） community screening. Methods A sample of 629 subjects （254 in COPD group, 375 in non-COPD group） were enrolled to undergo pulmonary function test （PFT） at our hospital. All subjects complete a postbronehodilator forced expiratory volume in 1 second （FEV1 ）/forced vital capacity （FVC） ratio of 〈 70% defined as COPD. A screening questionnaire was completed after PFF. And the data were collected and the measurement indices validated with the Chinese BMI classification. Results Area under curve-receiver operating characteristic （AUC-ROC） of original screening questionnaire was 0. 901 and the best cut-off value 19.5 （20） points. Modifying BMI, the measurement indices of the questionnaire were better than before. AUC-ROC of the modified questionnaire was 0. 916. The cut-off value was 16. 5 （17） points. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, Youden＇s index, positive predictive value, negative predictive value were 88.2%, 77.3%, 3.89, 0. 15, 0. 655, 72.5% and 90. 6% respectively. Conclusions The item of BMI in COPD screening questionnaire is modified according to the Chinese BMI classification standard. And a cut-off value of 17 points is recommended. And it enhances the ability of questionnaire screening.