老年人小气道功能障碍对静态肺功能指标的影响及其在劳动能力鉴定中的意义

目的：研究老年人小气道功能障碍对静态肺功能指标的影响及其在劳动能力鉴定中的意义。方法：根据纳入和剔除标准入选肺功能正常老年人组（对照组）60 例，单纯小气道功能障碍老年人组（观察组）94例，比较两组各项肺功能指标，并对小气道功能和静态肺功能指标做Pearson相关分析，残总比（RV/TL）、一氧化碳弥散量（DLCO）回归方程采用一元线性回归。结果：两组用力呼出50%肺活量时的瞬间呼气流速（V50）、用力呼出75%肺活量时的瞬间呼气流速（V25）和用力呼出25%～75%肺活量时的平均呼气流速（MMEF）3 个指标分别与肺总量（TLC）、DLCO呈正相关（r =0.272～0.527，P ＜0.05），与弥散比（KCO）均无相关性（P ＞0.05）；对照组RV/TLC与V25、MMEF呈负相关（r =-0.322，-0.376，P ＜0.05）；观察组RV/TLC与V50、MMEF呈负相关（r =-0.336，-0.250，P ＜0.05）；两组间TLC、功能残气量（FRC）、残气容积（RV）三个静态肺功能指标差异无统计学意义（P ＞0.05），RV/TLC、DLCO、KCO差异有统计学意义（P ＜0.001）RV/TLC、DLCO分别与V50、V25 和MMEF建立了相应的回归方程（r =0.322～0.544，F =6.719～63.755，P ＜0.05），继而获取DLCO、RV/TLC矫正公式：矫正值=实测值±α×ΔX（α=回归系数，ΔX=预计值-实际值）。结论：老年人单纯小气道功能障碍对静态肺功能指标存在着不同程度影响，针对已知存在非职业因素引起小气道功能障碍的职业病患者进行肺功能损伤评定时，建议RV/TLC、DLCO判断标准采用相应矫正公式以减少假阳性。

Effect of small airway dysfunction on static lung function index in the elderly and its significance in the identification of labor ability

Objective: To study the influence of small airway dysfunction on static lung function index in the elderly. Methods: According to the inclusion and elimination criteria, 60 cases of normal lung function group (control group) and 94 cases of simple small airway dysfunction group (observation group) were selected. The various lung function indicators were compared between the two groups. Persion correlation analysis of the small airway and static lung function indexes was performed, and uniary linear regression was used for the RV/TLC and DLCO regression equations. Results: V50, V25 and MMEF, the three indicators of both groups were positively associated with TLC, DLCO, respectively (r=0.272-0.527, P<0.05), and none was associated with KCO (P>0.05);RV/TLC in the control group was negatively associated with V25, MMEF (r=-0.322, -0.376, P<0.05); RV/TLC in the observation group was negatively associated with V50, MMEF (r=-0.336, -0.250, P<0.05). Both groups showed no significant difference (P>0.05) in TLC, FRC, RV, the three static lung function indicators, but very significant difference in RV/TLC, DLCO, KCO (P<0.001); RV/TLC, DLCO established the corresponding regressionequations with V50, V25 and MMEF respectively (r=0.322-0.544, F=6.719-63.755, P<0.05) and then DLCO,RV/TLC correction formula was acquired, i.e. corrective value=actual value±α×ΔX (α=regression coefficient,ΔX=expected-Actual). Conclusion: The elderly simple airway dysfunction affect static lung function indicators to varying degrees. It is recommended that the RV/TLC, DLCO judgment standard should adopt the corresponding correction formula to reduce false positives when assessing lung impairment in occupational disease patients with small airway dysfunction known to be caused by non-occupational factors.