便携式肺功能仪在社区慢阻肺筛查的可行性探索

目的探索便携式肺功能仪进行社区慢阻肺筛查的可行性。方法经短期培训20名医师操作便携式肺功能仪在社区行高危人群慢阻肺初筛,选取志愿者做传统肺功能测定验证,并用组内相关系数(ICC)和Bland-Altman图、ROC曲线等对其中的几个关键参数,用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC、 FEV1占预计值%(FEV1%pred)进行分析比较;Kappa分析诊断阻塞以及气道受限程度分级的敏感性和特异性。结果短期培训的医师可以操作便携式肺功能仪进行社区慢阻肺初筛。两型肺功能的测量参数FVC、FEV1、FEV1/FVC、FEV1%pred的相关性系数r分别为:0.897、0.790、0.840、0.563。便携式肺功能以舒张剂后的FEV1/FVC<70%作为诊断慢阻肺的标准,诊断敏感性为83.4%,如果以支气管舒张剂使用前FEV1/FVC 75%为诊断慢阻肺的标准,敏感性为91%。便携式肺功能仪诊断阻塞程度分级的准确性为49.2%。结论短期培训的医师可以使用便携式肺功能仪行慢阻肺初筛,便携式肺功能初筛结合传统肺功能定诊的模式,可以高效准确的诊断慢阻肺以及气道阻塞程度分级。

Feasibility analysis of screening COPD with portable pulmonary function test equipment in community

Objective To explore the feasibility of screening COPD with portable pulmonary function test equipment in community. Methods 20 physicians were trained to operate the portable pulmonary function test equipment to perform the primary screening of COPD in high-risk groups in the community. Volunteers were selected to do the traditional pulmonary function measurement. Several key parameters, such as FVC, FEV1, FEV1% pred and FEV1/FVC, were analyzed and compared with each other by using the Intraclass correlation coefficient(ICC), Bland-Altman graph and ROC curve. The sensitivity and specificity of kappa analysis were used to diagnose obstruction and grade the degree of airway restriction. Results Short-term trained physicians could operate the portable pulmonary function test equipment to perform the initial screening of community COPD. The correlation coefficients of FVC, FEV1, FEV1/FVC and FEV1%pred between the two types of pulmonary function were 0.897 and 0.790, 0.840 and 0.563, respectively. The gold standard of portable pulmonary function test was FEV1/FVC<70%, and the diagnostic sensitivity was 83.4%. If FEV1/FVC<75% was used before bronchodilator, the sensitivity was 91%. The accuracy of the portable lung function instrument in diagnosing the degree of obstruction was 49.2%. Conclusion Short-term trained physicians can use portable pulmonary function test equipment to screen COPD. The portable primary lung function screening combined with the traditional lung function diagnosis mode can effectively and accurately diagnose COPD and grade the degree of airway obstruction.