不同肺功能诊断标准对慢性阻塞性肺疾病患病率的影响

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。

Comparison of the Prevalence of Chronic Obstructive Pulmonary Disease in Different Spirometric Criteria

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 Hos-pital of Fujian Medical University from January 1 ,2013 to December 30 ,2013 . 617 patients were en-rolled 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 . Results With criteria LLNA ,the prevalence was 16 .7% ,with 3 .9% under 40 years old ,11 .1% between 40~59 years old ,17 .4% between 60~69 years old and 28 .1% over 70 years old .With GOLD criteria ,the preva-lence of 40~59 years 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 preva-lence 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 LLNA and 0 .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 .