【摘要】 目的研究以一秒率(FEV1/FVC)固定临界值70%,占预计值92%和正常值低限(LLN)为诊断标准对慢性阻塞性肺疾病(COPD)患病率的影响。方法选择2013年1-12月进行肺功能检查的体检者开展以医院为现场的流行病学调查,将符合标准的617例患者分别按照以下诊断标准计算COPD的患病率:(1)FEV1/FVC<复旦大学附属中山医院计算出的一秒率LLN(LLN中山);(2)《慢性阻塞性肺疾病全球防治倡议》(GOLD)标准(FEV1/FVC<70%);(3)FEV1/FVC<复旦大学附属中山医院计算出的预计值×92%;(4)FEV1/FVC<哈尔滨医科大学公共卫生学院计算出的LLN预计值(LLN哈)。比较以上几种诊断方法COPD的患病率和诊断一致性。结果以LLN中山为标准COPD的总患病率为16.7%,<40岁人群患病率3.9%,40~59岁人群患病率11.1%,60~69岁人群患病率17.4%,>70岁人群患病率28.1%。GOLD标准40~59岁人群患病率4.8%,低于LLN中山,>70岁人群患病率36.3%,高于LLN中山(P<0.05),余年龄组与总患病率差别无统计学意义;各组的诊断一致率为87.6%~96.1%。方法(3)、方法(4)与方法(1)比较,各年龄组人群患病率与总患病率差别均无统计学意义(P>0.05),诊断一致率95.4%~100%。结论以GOLD标准作为COPD诊断标准可能造成低年龄组漏诊和高年龄组过度诊断。以FEV1/FVC预计值×92%与以LLN中山为标准诊断COPD一致性好,可考虑作为COPD的诊断标准。更多还原

【Abstract】 Objective To investigate the impact of using fixed ratio 70%,the prediction of FEV1/FVC plus 0.92,the lower limit of normal(LLN)for FEV1/FVC as cut-off point for diagnosis of chronic obstructive pulmonary disease(COPD)on the prevalence of COPD. Methods An epidemiological study was carried out in physical examination people who had pulmonary function test in the First Affiliated Hospital of Fujian Medical University from January 1,2013 to December 30,2013. 617 patients were enrolled and diagnosed as COPD by different spirometric criteria as follows.(1)FEV1/FVC<LLNA,which was calculated from the data of zhongshan hospital in 2010;(2)GOLD criteria,that is FEV1/FVC<70%;(3)FEV1/FVC<0.92 plus the predictive value of FEV1/FVC from Zhongshan Hospital,Fudan University in 2010;(4)FEV1/FVC<LLNB,which was provided by haerbing Medical College in 2001.The different prevalence was compared and the diagnostic concordance rate was calculated. ResultsWith criteria LLNA,the prevalence was 16.7%,with 3.9% under 40 years old,11.1% between 40~59years old,17.4%between 60~69years old and 28.1%over 70 years old.With GOLD criteria,the prevalence of 40~59years old was lower than criteria LLNA,while the prevalence of over 70 years old group was higher than LLNA(P<0.05). The diagnostic concordance rate was 87.6%~96.1%. The prevalence of COPD was similar with criteria LLNA,criteria LLNB and criteria(3),the diagnostic concordance rate was 95.4%~100%. Conclusions Using GOLD criteria as cut-off to diagnose COPD may result in missed diagnosis in low age and over diagnosis in old age. The diagnostic concordance rate of LLNAand0.92 plus prediction values of FEV1/FVC was high,so 0.92 plus prediction values of FEV1/FVC maybe a good new way to diagnose COPD.更多还原