Brunelli Alessandro, Refai Majed Al, Salati Michele, Sabbatini Armando, Morgan-Hughes Nicholas J, Rocco Gaetano
Unit of Thoracic Surgery, "Umberto I" Regional Hospital, Via S. Margherita 23, Ancona 60129, Italy.
Eur J Cardiothorac Surg. 2006 Apr;29(4):567-70. doi: 10.1016/j.ejcts.2006.01.014. Epub 2006 Feb 14.
In many centers, carbon monoxide lung diffusion capacity (DLCO) is still not routinely measured in all patients but only in patients with airflow limitation. The objective of the study was to assess the degree of correlation between forced expiratory volume in 1s (FEV1) and DLCO, and verify whether a low predicted postoperative DLCO (ppoDLCO) could have a role in predicting complications in patients without airflow limitation.
We analyzed 872 patients submitted to lung resection between January 2000 and December 2004 in two units measuring systematically DLCO before operation. Correlation between FEV1 and DLCO was assessed in the entire dataset and in different subsets of patients. A number of variables were then tested for a possible association with postoperative cardiopulmonary complications in patients with FEV1>80% by univariate analysis. Variables with p<0.10 at univariate analysis were used as independent variables in a stepwise logistic regression analysis (dependent variable: presence of cardiopulmonary morbidity), which was in turn validated by bootstrap analysis.
The correlation coefficients between FEV1 and DLCO in the entire dataset and in different subsets of lung resection candidates (stratified by age, gender, cause of operation, airflow limitation) were all below 0.5, showing a modest degree of correlation. Two hundred and nineteen of the 508 patients (43%) with FEV1>80% had DLCO<80%. Moreover, in patients with FEV1>80%, logistic regression analysis showed that ppoDLCO<40% was a significant and reliable predictor of postoperative complications (p=0.004).
The modest correlation between FEV1 and DLCO and the capacity of ppoDLCO to discriminate between patients with and without complications in subjects with a normal FEV1, warrants the routine measurement of DLCO in all candidates for lung resection, irrespective of their FEV1 value, in order to improve surgical risk stratification.
在许多医疗中心，并非对所有患者常规测量一氧化碳肺弥散量（DLCO），而仅对存在气流受限的患者进行测量。本研究的目的是评估一秒用力呼气容积（FEV1）与DLCO之间的相关程度，并验证术后预测DLCO低值（ppoDLCO）在预测无气流受限患者并发症方面是否具有作用。
我们分析了2000年1月至2004年12月期间在两个术前系统测量DLCO的科室接受肺切除术的872例患者。在整个数据集中以及不同患者亚组中评估FEV1与DLCO之间的相关性。然后通过单因素分析测试多个变量与FEV1>80%患者术后心肺并发症的可能关联。单因素分析中p<0.10的变量用作逐步逻辑回归分析中的自变量（因变量：心肺疾病的存在），该分析随后通过自举分析进行验证。
整个数据集中以及不同肺切除候选亚组（按年龄、性别、手术原因、气流受限分层）中FEV1与DLCO之间的相关系数均低于0.5，显示出中等程度的相关性。508例FEV1>80%的患者中有219例（43%）DLCO<80%。此外，在FEV1>80%的患者中，逻辑回归分析显示ppoDLCO<40%是术后并发症的显著且可靠的预测指标（p=0.004）。
FEV1与DLCO之间的中等相关性以及ppoDLCO在FEV1正常的患者中区分有无并发症患者的能力，表明应对所有肺切除候选者常规测量DLCO，无论其FEV1值如何，以改善手术风险分层。
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