FEV1/FEV6 is effective as a surrogate for FEV1/FVC in the diagnosis of chronic obstructive pulmonary disease

Background and objectiveChronic Obstructive Pulmonary Disease (COPD) causes substantial morbidity and mortality across the globe. Diagnosis of COPD requires post-bronchodilator FEV1/FVC <0.70 as per GOLD Guidelines. FVC maneuver requires a minimum of 6 seconds of forceful expiration with no flow for 1 second for an accepted effort, which lacks any fixed cut-off point. This leads to discomfort, especially in advanced COPD and old aged population. We conducted this study to find the utility of FEV1/FEV6 as a surrogate for FEV1/FVC, the correlation between the two ratios, and the fixed cut-off value of FEV1/FEV6 for COPD diagnosis.MethodsThis was a prospective, cross-sectional study approved by the institutional ethics committee conducted from January 2017 to November 2018. Consented patients above 18 years suspected of COPD underwent Spirometry as per ATS guidelines. FEV1, FEV6, FEV1/FEV6 and FEV1/FVC ratios were recorded from the best acceptable maneuver.ResultsOut of 560 screened patients, 122 diagnosed as COPD. The correlation coefficient between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio was 0.972 (p < 0.01). The relationship between the post-bronchodilator FEV1/FVC ratio and FEV1/FEV6 ratio (linear regression analysis) was found out as: FEV1/FVC = ?1.845 + 1.009(FEV1/FEV6). Using this formula, the post-bronchodilator FEV1/FEV6 value of 71.845 was obtained corresponding to the post-bronchodilator FEV1/FVC value of 70.00.ConclusionWe found a positive correlation coefficient (r = 0.972, p < 0.001) between the FEV1/FEV6 and FEV1/FVC ratios and the cut off value of 71.845 (p < 0.01) for the post-bronchodilator FEV1/FEV6 ratio for the diagnosis of COPD. Thus FEV1/FEV6 should be used as a surrogate for FEV1/FVC for the diagnosis of COPD.     

FEV1/FEV6 and FEV6 as an alternative for FEV1/FVC and FVC in the spirometric detection of airway obstruction and restriction

STUDY OBJECTIVES: To evaluate the use of the FEV(1)/forced expiratory volume at 6 s of exhalation (FEV(6)) ratio and FEV(6) as an alternative for FEV(1)/FVC and FVC in the detection of airway obstruction and lung restriction, respectively. SETTING: Pulmonary function laboratory of the Academic Hospital of the Free University of Brussels. PARTICIPANTS: A total of 11,676 spirometric examinations were analyzed on subjects with the following characteristics: white race; 20 to 80 years of age; 7,010 men and 4,666 women; and able to exhale for at least 6 s. METHODS: Published reference equations were used to determine lower limits of normal (LLN) for FEV(6), FVC, FEV(1)/FEV(6), and FEV(1)/FVC. We considered a subject to have obstruction if FEV(1)/FVC was below its LLN. A restrictive spirometric pattern was defined as FVC below its LLN, in the absence of obstruction. From these data, sensitivity and specificity of FEV(1)/FEV(6) and FEV(6) were calculated. RESULTS: For the spirometric diagnosis of airway obstruction, FEV(1)/FEV(6) sensitivity was 94.0% and specificity was 93.1%; the positive predictive value (PPV) and negative predictive value (NPV) were 89.8% and 96.0%, respectively. The prevalence of obstruction in the entire study population was 39.5%. For the spirometric detection of a restrictive pattern, FEV(6) sensitivity was 83.2% and specificity was 99.6%; the PPVs and NPVs were 97.4% and 96.9%, respectively. The prevalence of a restrictive pattern was 15.7%. Similar results were obtained for male and female subjects. When diagnostic interpretation differed between the two indexes, measured values were close to the LLN. CONCLUSIONS: The FEV(1)/FEV(6) ratio can be used as a valid alternative for FEV(1)/FVC in the diagnosis of airway obstruction, especially for screening purposes in high-risk populations for COPD in primary care. In addition, FEV(6) is an acceptable surrogate for FVC in the detection of a spirometric restrictive pattern. Using FEV(6) instead of FVC has the advantage that the end of a spirometric examination is more explicitly defined and is easier to achieve.     

Poor interpretation of pulmonary function tests in patients with concomitant decreases in FEV1 and FVC

Background and objective:   A new interpretative strategy for pulmonary function tests (PFT) has been proposed by the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force. To assess the accuracy of this strategy, clinical diagnosis was compared with the PFT interpretation in patients showing concomitant decreases in FEV₁ and FVC.
Methods:   A retrospective study was conducted of 681 patients with normal FEV₁/FVC and low FVC who underwent lung volume measurements and spirometry on the same date between July and November 2005 at Asan Medical Center, Seoul, Korea. Patients were clinically diagnosed by the consensus decision of two respiratory physicians, and the kappa coefficient was calculated to compare the clinical diagnosis with the PFT interpretation using the ATS/ERS strategy.
Results:   The PFT interpretation showed an obstructive pattern in 205 patients and a restrictive pattern in 476. Of the 205 patients with an obstructive pattern on PFT, 44 were clinically diagnosed with obstructive, 97 with restrictive and 17 with mixed disease, whereas 47 patients had no disease. Of the 476 patients with a restrictive pattern on PFT, 11 were clinically diagnosed with obstructive, 369 with restrictive and 60 with mixed disease, whereas 36 patients had no disease. The kappa coefficient was 0.35 (95% confidence interval: 0.26–0.44; P  < 0.0001).
Conclusions:   The weak agreement between the clinical diagnosis and the PFT interpretation in patients showing concomitant decreases in FEV₁ and FVC suggests that other clinical findings should be assessed in addition to PFT.     

轻度认知功能障碍向阿尔茨海默病转化的预测研究进展

轻度认知功能障碍（MCI）是介于正常衰老与痴呆之间的认知功能缺损状态,MCI进展为阿尔茨海默病（AD）的危险性较高,故MCI阶段可能是进行AD预防性治疗的最合适阶段,因而成为研究的焦点。本文就近年来MCI向AD的转化预测研究做一综述,主要包括五个方面：神经心理学测试、生物标志物检查、神经影像学检查、脑电生理学检查及其治疗进展。     

Quality of life of the community-based patients with mild cognitive impairment

Aim:   To determine quality of life (QOL) in patients with mild cognitive impairment (MCI) compared to normal subjects and to investigate the impact of demographic factors on QOL.
Methods:   There were 122 participants aged 50 and over, diagnosed with MCI ( n  = 85) or normal ( n  = 37) recruited from a community-based setting in Bangkok. The Thai version of the World Health Organization Quality of Life (WHOQOL-BREF-THAI) was used to assess the QOL in the subjects.
Results:   The MCI patients had significantly lower psychological QOL compared to normal subjects. The MCI patients with low education had poorer total QOL scores, and patients with poor financial status had poorer psychological QOL scores and total QOL scores. The MCI patients who lived alone had poorer social relationship QOL. There were correlations between the Thai version of Geriatric Depression Scale (TGDS) and physical QOL, TGDS and psychological QOL, and TGDS and total QOL scores. The depression subscale of the Neuropsychiatric Inventory had negative correlation with physical and psychological QOL.
Conclusion:   The MCI patients had poorer psychological QOL than normal subjects. Low education, poor financial status, living alone and depressive symptoms had an influence on the quality of life.     

Comparison of cognitive performance in mild cognitive impairment and dementia patients with that in normal children and adults

Background: It is well known that there is rapid cognitive development in childhood and cognitive decline during aging, but the volume of these changes using the same clinical tool is not well documented in the literature. The aim of our study was to investigate and compare the cognitive performance of mild cognitive impairment (MCI) and dementia patients with that of children, adolescents and adults, using a worldwide screening tool, the Mini Mental State Examination (MMSE), and considering the age, educational level and mental status of the participants. Methods: Our sample included 1364 Greek participants and consisted of normal children, adolescents, adults and non‐demented, MCI and demented elderly participants. Results: The variables of age, education and mental status influenced the participant's performance in the MMSE, but sex did not. The smallest variance of the MMSE score was found in 16–18‐year‐old adolescents, a big variance was found in 7–8‐year‐old children, while the biggest was in 71–90‐year‐olds. Alzheimer's disease (AD) participants performed poorer than the 7–8 years old children, though MCI participants showed similar cognitive performance to that age‐group. The participants with 7–9 years of schooling and those with more than 9 years had no significant difference in their MMSE performance. Conclusion: Comparing cognitive performance between subgroups, our results indicated that MCI patients have a similar cognitive performance to that of 7–8‐year‐old children and AD patients' a poorer one than that group. The significant years of cognitive decline in aging are the 56^th year, the 66 quinquennium, and the 7^th and 8^th decades. Geriatr Gerontol Int 2012; 12: 336–344.     

机关背景80岁以上轻度认知障碍患者MoCA量表特征研究

目的研究机关背景≥80岁轻度认知障碍（MCI）患者蒙特利尔认知评估（Montreal cognitive assessment，MocA）量表结果的特点。方法选择83例南京地区机关背景的≥65岁人群为研究对象，通过MoCA量表检查结合临床表现诊断是否为MCI患者。研究对象共分3组：〈80岁MCI患者（A组，n=33），≥80岁MCI患者（B组，n=26），≥80岁非MCI患者（c组，n=24）。分析3组MoCA量表得分差异。结果B组患者的视空间能力和语言流畅性得分明显低于A组和c组，而A组患者血清胆固醇水平、血小板聚集率明显高于B组和c组。结论由于脑动脉硬化等原因，≥80岁MCI患者的执行能力较相对年轻的MCI患者和同年龄非MCI人群明显减退。     

社区老年2型糖尿病患者合并轻度认知功能障碍危险因素分析

目的探讨分析2型糖尿病患者轻度认知功能障碍（mild cognitive impairment,MCI）的相关危险因素。方法以简易智能精神状态量表（MMSE）对社区老年2型糖尿病患者进行认知功能测评,收集MCI患者82例（MCI组）,认知功能正常者86例（NC组）。问卷调查受试者病史、年龄、糖尿病肾病、糖尿病足等资料;测定受试者血压、身高、体质量、血脂、血糖、胰岛素（Ins）、糖化血红蛋白（HbA1c）;计算胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、体质量指数（BMI）、腰臀比（WHR）并筛查其危险因素。结果（1）与NC组比较,MCI组患者糖尿病病程、糖尿病肾病、空腹血糖（FBG）、餐后2h血糖（2hPBG）、空腹胰岛素（Fins）、HbA1c、HOMA—IR水平显著升高;而2组间年龄、糖尿病足、BMI、WHR、血压、餐后2h胰岛素（2hlns）、HOMA-B及血脂水平比较,差异均无统计学意义。（2）MCI患者MMSE量表评分与糖尿病病程、FBG、2hPBG、Fins、HOMA—IR具有相关性;而NC组仅发现与糖尿病病程、FBG相关。（3）Logistic回归分析显示糖尿病病程、FBG、HOMA-IR可能与糖尿病患者MCI独立相关。结论糖尿病病程、血糖控制水平、胰岛素抵抗程度等可能与2型糖尿病患者发生MCI密切相关,有效控制各危险因素有助于预防认知功能障碍的发生发展。     

代谢综合征、基质金属蛋白酶-9活性与老年人轻度认知功能障碍的相关性研究

目的 探讨老年患者代谢综合征(MS)与轻度认知功能障碍(MCI)的相关性及基质金属蛋白酶9(MMP-9)活性的作用.方法 采用简明智力状态量表(MMSE)对135例MS患者及75例健康老年人(对照组)进行认知功能评定;通过测定MMP-9和金属蛋白酶组织抑制因子1(TIMP-1)的血清浓度,计算MMP-9∶TIMP-1比值作为MMP-9的活性指标.结果 MS组MCI的发生率显著高于对照组(22.2% vs 9.33%,P＜0.05);MS组的MMSE评分显著低于对照组[(26.12±1.15) vs (29.37±0.58),P＜0.05];MS组的MMP-9活性则显著高于对照组[(0.81±0.35)vs(0.59±0.27),P＜0.05],在MS组内MMP-9活性与MMSE呈显著性负相关(r=-0.519,P＜0.05);文化程度高是MCI的保护性因素(OR=0.615,P=0.023),而MS、糖尿病和MMP-9活性是MCI发生的独立危险因素(OR1=6.981,P1=0.011;OR2=6.250,P2=0.017;OR3=3.262,P3=0.031).结论 MS是MCI的独立危险因素,MS患者的MMP-9活性水平与其认知功能损伤的程度呈正相关.     

中老年心房颤动患者轻度认知功能障碍的影响因素分析

目的：分析中老年非瓣膜性心房颤动（Atrial Fibrillation）患者轻度认知功能障碍（Mild Cognitive Impairment）的状况及其影响因素。方法：纳入自2019年10月至2020年6月就诊于应急总医院心内科及干部医疗科的非瓣膜性心房颤动患者106例,完成记忆、注意、语言、执行、视空间功能五大认知域的神经精神量表的筛查,分为轻度认知功能障碍组和认知功能正常组。采用多因素logistic分析探讨非瓣膜性心房颤动患者轻度认知功能障碍的影响因素。结果：106例患者中有58例为轻度认知功能障碍,平均年龄63岁,MCI组的房颤类型（持续/永久房颤）（P=0.017）、高血压病史比例（P=0.002）,CHA2DS2-VASc评分（P=0.047）,左房前后径（P=0.038）较正常认知组高,血红蛋白在MCI组偏低（P=0.034）,logistic回归分析发现非瓣膜性房颤人群的认知功能障碍与房颤类型、高血压、糖尿病病史、血红蛋白量相关。结论：房颤和认知功能障碍的发生都随着年龄增大而增加,房颤患者的发病类型、高血压、糖尿病病史和血红蛋白水平是发生轻度认知功能障碍的危险因素,早期识别轻度认知功能障碍对缓解认知进一步下降至关重要。     

从神经心理学和影像学探讨加味五子衍宗颗粒对轻度认知障碍患者的影响

目的　研究补肾方加味五子衍宗颗粒对轻度认知障碍 (MCI)患者记忆功能及脑 CT的影响。方法　参考目前国际公认的 MCI诊断标准 ,筛选出 44名 MCI患者 ,采用随机双盲、双模拟方法 ,分为加味五子衍宗治疗组和银杏叶对照组 ,服药 3个月 ,观察用药前后记忆功能及脑 CT的变化。 2 0名健康者为正常对照。结果　 MCI组的记忆商 (MQ)较正常对照组明显降低 (P<0 .0 1 ) ,海马指数和颞角宽度较正常对照组明显增高 (P<0 .0 1 ,P<0 .0 5)。治疗后加味五子衍宗治疗组和银杏叶对照组的 MQ均较治疗前明显提高 (P<0 .0 1 ) ,海马指数和颞角宽度较治疗前明显变小 (P<0 .0 5)。结论　加味五子衍宗丸治疗 MCI有较好的临床疗效。     

Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies

This study examined the association of diabetes with the onset of dementia (including Alzheimer's disease (AD), vascular dementia (VD) and any dementia) and mild cognitive impairment (MCI) by using a quantitative meta-analysis of longitudinal studies. EMBASE and MEDLINE were searched for articles published up to December 2010. All studies that examined the relationship between diabetes and the onset of dementia or MCI were included. Pooled relative risks were calculated using fixed and random effects models. Nineteen studies met our inclusion criteria for this meta-analysis, and 6184 subjects with diabetes and 38 530 subjects without diabetes were included respectively. All subjects were without dementia or MCI at baseline. The quantitative meta-analysis showed that subjects with diabetes had higher risk for AD (relative risk (RR):1.46, 95% confidence interval (CI): 1.20-1.77), VD (RR: 2.48, 95% CI: 2.08-2.96), any dementia (RR: 1.51, 95% CI: 1.31-1.74) and MCI (RR: 1.21, 95% CI: 1.02-1.45) than those without. The quantitative meta-analysis showed that diabetes was a risk factor for incident dementia (including AD, VD and any dementia) and MCI.     

Association between DNA methylation of SORL1 5′-flanking region and mild cognitive impairment in type 2 diabetes mellitus

Objectives

In the present study, we examined whether DNA methylation of the sortilin-related receptor 1 (SORL1) 5′-flanking region is associated with the manifestation and clinical presentation of mild cognitive impairment in type 2 diabetes mellitus (T2DM).

Methods

Of 84 diabetic patients with mild cognitive impairment (MCI group), 78 diabetic patients without mild cognitive impairment (NMCI group) and 80 age-matched normal controls (NC group), the DNA methylation of the SORL1 5′-flanking region was completely analyzed. The SORL1 methylation ratios of the above three groups were compared statistically. Next, we investigated the correlation between the DNA methylation status and the clinical presentation of diabetes with or without cognitive impairment (MCI and NMCI groups).

Results

The methylation ratio (86.9%) of MCI patients was significantly higher than that in the NMCI patients (35.9%, P < 0.05) and in the NC group (11.3%, P < 0.05). Moreover, the diabetic patients with methylation alleles had greater ages, longer diabetes duration, lower MOCA scores and higher plasma amyloid Aβ 1-42 levels than those with unmethylation alleles (P < 0.05).

Conclusion

These results suggested that the DNA methylation of the SORL1 5′-flanking region may significantly influence the manifestation of mild cognitive impairment in T2DM, and might be associated with its neurocognitive presentation.     

老年人杓型高血压晨峰现象与轻度认知功能障碍、踝肱指数、尿蛋白/肌酐的相关性分析

目的研究老年人杓型高血压晨峰(morning blood pressure surge,MBPS)现象与轻度认知功能障碍(mild cognitive impairment,MCI)、踝肱指数(ankle brachial index,ABI)、尿微量白蛋白/肌酐(UmAlb/Cr)的关系,探讨老年人杓型高血压MBPS对动脉粥样硬化的影响。方法 458例老年杓型高血压患者,根据动态血压监测结果分为MBPS组及NMBPS组,所有患者均进行简短精神状态量表(mini-mental state examination,MMSE)、ABI、UmAlb/Cr检测,并常规检测血尿素氮(BUN)、肌酐(Cr)、血糖(Glu)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC),分析2组MMSE评分、ABI、UmAlb/Cr的差异。结果 2组患者在性别、年龄、高血压病程、BUN、Cr、Glu、HDL-C、LDL-C、TG、TC比较差异均无统计学意义(P0.05)。MBPS组24hSBP、dSBP、nSBP、24hMAP、dMAP、收缩压晨峰变异幅度均高于NMBPS组,差异具有统计学意义(P0.05或P0.01)。MBPS组与NMBPS组比较,MMSE评分、ABI显著降低,UmAlb/Cr显著升高,MBPS组MCI发生率、外周动脉血管闭塞性疾病(PAD)发生率、UmAlb/Cr阳性率均高于NMBPS组,差异具有统计学意义(P0.01)。Pearson相关分析显示,MBPS与MCI、ABI、UmAlb/Cr呈中度相关,与年龄呈低相关,差异具有统计学意义(P0.05或P0.01)。结论老年人杓型高血压MBPS是导致MCI、PAD以及早期肾损害的重要危险因素,对动脉粥样硬化产生重要影响。     

蒙特利尔认知评估量表用于血管源性轻度认知功能障碍评估的初步研究

目的探讨蒙特利尔认知评估量表（MoCA）中文北京版用于血管源性轻度认知功能障碍评估的可行性。方法应用MoCA和简易智能状态检查量表（MMSE）分别对50例血管源性轻度认知功能障碍（vMCI）患者和50例健康体检者进行认知功能评估,分析评估结果。结果对照组和vMCI组MoCA和MMSE总分有较好相关性（P〈0.05）,MoCA评分明显低于MMSE（P〈0.05）;与对照组比较v,MCI组MoCA各条目得分及总分均明显降低（P〈0.05）;MoCA筛查vMCI灵敏度为84.0%、特异度为76.0%,MMSE分别为46.0%和98.0%。结论 MoCA用作血管源性轻度认知功能障碍认知功能筛查时敏感性优于MMSE。