Donohue James F
Division of Pulmonary Diseases and Critical Care Medicine, School of Medicine, University of North Carolina at Chapel Hill, CB# 7020, 4125 Bioinformatics Building, Chapel Hill, North Carolina 27599-7020, USA.
COPD. 2005 Mar;2(1):111-24. doi: 10.1081/copd-200053377.
The FEV1 is widely used by physicians in the diagnosis, staging, treatment, monitoring, and establishing prognosis for patients with COPD. The MCID is the smallest difference which patients perceive as beneficial and which would mandate a change in patient management. A precise MCID for FEV1 has not been established. In attempt to establish a MCID for predose or trough FEV1, several limitations need to be addressed. There are issues such as reproducibility, repeatability, acceptability, variability, placebo effect, and equipment effects. Patient factors, such as baseline level of FEV1, albuterol reversibility, diurnal variation, influence the results. Nonetheless, using anchoring techniques, a change in pre dose FEV1 of about 100 mL can be perceived by patients, correlates with fewer relapses following exacerbations and is in the range usually achieved with bronchodilators approved for COPD. In the future, consistent reporting of spirometric variables, such as a predose FEV1 and other outcomes, can be incorporated into a more quantitative effort to establish the MCID. Also distributional/statistical methods may be useful in determining the MCID FEV1.
第一秒用力呼气容积（FEV1）被医生广泛用于慢性阻塞性肺疾病（COPD）患者的诊断、分期、治疗、监测及预后评估。最小临床重要差异（MCID）是患者认为有益且会促使改变患者管理方式的最小差异。目前尚未确定FEV1的精确MCID。为了确定用药前或谷值FEV1的MCID，需要解决几个限制因素。存在诸如可重复性、可复验性、可接受性、变异性、安慰剂效应和设备效应等问题。患者因素，如FEV1的基线水平、沙丁胺醇可逆性、日变化等，会影响结果。尽管如此，采用锚定技术，患者可察觉到用药前FEV1约100 mL的变化，这与急性加重后较少的复发相关，且处于通常使用的COPD批准支气管扩张剂所能达到的范围内。未来，肺活量测定变量（如用药前FEV1和其他结果）的一致报告可纳入更定量的工作中以确定MCID。分布/统计方法在确定FEV1的MCID方面可能也有用。
