Akhtar Rashed, Wilson Andrew
Department of Health Sciences, Division of General Practice & Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK.
Prim Care Respir J. 2005 Aug;14(4):215-20. doi: 10.1016/j.pcrj.2004.12.005.
: To compare the results of spirometry testing in primary care with those obtained at a pulmonary function laboratory and to explore whether differences were due to technique or equipment.
: Patients on the waiting list for spirometry in six participating practices had the test performed in their own practice and at the pulmonary function laboratory (PFL).
: A total of 45 patients had spirometry performed at both locations. Practice nurses underestimated FEV(1) and FVC. The mean difference in FEV(1) was 0.109litres (6.69%, 95% CI 2.88, 9.51) compared with a bellows spirometer, and 0.07litres (6.2% 95% CI 0.89, 8.25) when the same type of spirometer was used. The mean difference in FVC was 0.413litres (15.0% 95% CI 9.3, 20.6) when compared with bellows, and 0.267litres (10.2% 95% CI 4.1, 16.2) when the same type of spirometer was used. All differences were statistically significant (p<0.05, paired t test). Agreement on categorization of COPD was moderate (Kappa 0.46) with practice nurses overestimating severity. Compared to PFL categorisation for the presence or absence of COPD using bellows spirometers, the sensitivity of practice nurse spirometry was 0.93 (95% CI: 0.76, 0.99) and specificity 0.65 (95% CI: 0.38, 0.86).
: Spirometry results obtained by practice nurses were lower than those obtained in a PFL, leading to over-diagnosis of COPD severity.
比较基层医疗中肺活量测定测试结果与在肺功能实验室获得的结果，并探讨差异是否归因于技术或设备。
在六个参与诊所中等待肺活量测定的患者在其所在诊所和肺功能实验室（PFL）进行测试。
共有45名患者在两个地点都进行了肺活量测定。诊所护士低估了第一秒用力呼气容积（FEV₁）和用力肺活量（FVC）。与风箱式肺活量计相比，FEV₁的平均差异为0.109升（6.69%，95%可信区间2.88，9.51），使用同类型肺活量计时平均差异为0.07升（6.2%，95%可信区间0.89，8.25）。与风箱式肺活量计相比，FVC的平均差异为0.413升（15.0%，95%可信区间9.3，20.6），使用同类型肺活量计时平均差异为0.267升（10.2%，95%可信区间4.1，16.2）。所有差异均具有统计学意义（p<0.05，配对t检验）。慢性阻塞性肺疾病（COPD）分类的一致性为中等（Kappa值0.46），诊所护士高估了严重程度。与使用风箱式肺活量计的PFL对COPD存在与否的分类相比，诊所护士肺活量测定的敏感性为0.93（95%可信区间：0.76，0.99），特异性为0.65（95%可信区间：0.38，0.86）。
诊所护士获得肺活量测定结果低于在肺功能实验室获得的结果，导致对COPD严重程度的过度诊断。
