GLI - 2012肺量计参考值及正常下限对泰国城市老年人慢性阻塞性肺疾病患病率的影响
Impact of GLI-2012 Spirometric References and Lower Limit of Normal on Prevalence of COPD in Older Urban Thai Persons.
作者信息
Dejsomritrutai Wanchai, Chuaychoo Benjamas
出版信息
J Med Assoc Thai. 2016 Mar;99(3):276-81.
BACKGROUND
Previous analysis of survey data from a study in older urban Thai persons reported prevalence of chronic obstructive pulmonary disease (COPD) of 7.11% according to formerly recommended criteria that used fixed ratio (70%) of pre-bronchodilator FEV1/FVC as the cut-off value. In 2012, the Global Lung Initiative (GLI)-2012 equations for spirometric reference were established and the diagnostic criteria for COPD were changed.
OBJECTIVE
To reanalyze the data collected during the 2002 respiratory health survey to determine prevalence of COPD in older urban Thai persons according to the new GLI-2012 equations.
MATERIAL AND METHOD
Demographic and clinical data of 3,094 subjects aged ≥ 60 years from 124 urban communities were re-analyzed. Prevalence of COPD determined by post-bronchodilator FEV1/FVC and GLI-2012 equations using lower limit of normal by the Lambda-Mu-Sigma method (LMS-LLN) was compared to COPD prevalence findings based on criteria used in previous analysis.
RESULTS
Prevalence of COPD in the study population using post-bronchodilator FEV1/FVC and LMS-LLN was 6.50% (95% CI: 5.63-7.3 7), compared with 7.82% (95% CI: 6.87-8.77) when fixed ratio (70%) of FEV1/FVC was used as cut-off. Diagnostic agreement of COPD between LMS-LLN and fixed ratio was high (kappa 0.88, p < 0.0001). However 45/242 (18.6%) subjects diagnosed as COPD by fixed ratio criteria were considered as "over-diagnosed" when LMS-LLN was used as the standard cut-off The same comparison applied to subjects aged 80 years revealed an increased rate of over-diagnosis to 7/22 (31.8%) subjects. Higher agreement was observed (kappa 0.95, p < 0.0001) when comparing between cut-offs for diagnosis of "at least GOLD stage II" COPD.
CONCLUSION
Prevalence of COPD in older urban Thai persons was lower when LMS-LLN was substituted for fixed ratio (70%) of FEV1/FVC. Agreement in COPD diagnosis between both criteria was high, but a substantial proportion of subjects may be over-diagnosed
背景
先前对泰国城市老年人一项研究的调查数据进行分析时，根据以前推荐的标准（使用支气管扩张剂前FEV1/FVC的固定比例70%作为临界值）报告慢性阻塞性肺疾病（COPD）患病率为7.11%。2012年，全球肺部倡议组织（GLI）-2012肺量计参考方程得以确立，COPD的诊断标准也发生了变化。
目的
重新分析2002年呼吸健康调查期间收集的数据，以根据新的GLI-2012方程确定泰国城市老年人中COPD的患病率。
材料与方法
对来自124个城市社区的3094名年龄≥60岁受试者的人口统计学和临床数据进行重新分析。将使用支气管扩张剂后FEV1/FVC和采用Lambda-Mu-Sigma方法的正常下限（LMS-LLN）的GLI-2012方程确定的COPD患病率，与基于先前分析中使用的标准得出的COPD患病率结果进行比较。
结果
使用支气管扩张剂后FEV1/FVC和LMS-LLN时，研究人群中COPD的患病率为6.50%（95%置信区间：5.63-7.37），而以FEV1/FVC的固定比例70%作为临界值时为7.82%（95%置信区间：6.87-8.77）。LMS-LLN与固定比例之间COPD的诊断一致性较高（kappa值为0.88，p<0.0001）。然而，当以LMS-LLN作为标准临界值时，45/242（18.6%）名根据固定比例标准被诊断为COPD的受试者被视为“过度诊断”。对80岁受试者进行同样的比较显示，过度诊断率增至7/22（31.8%）名受试者。在比较“至少GOLD II级”COPD的诊断临界值时，观察到更高的一致性（kappa值为0.95，p<0.0001）。
结论
当用LMS-LLN替代FEV1/FVC的固定比例70%时，泰国城市老年人中COPD的患病率较低。两种标准在COPD诊断方面的一致性较高，但有相当一部分受试者可能被过度诊断。
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