Kainu Annette, Timonen Kirsi, Lindqvist Ari, Piirilä Päivi
Heart and Lung Center, Peijas Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Dept of Clinical Physiology, Central Hospital of Central Finland, Jyväskylä, Finland; Dept of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
ERJ Open Res. 2016 Oct 19;2(4). doi: 10.1183/23120541.00084-2015. eCollection 2016 Oct.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria for chronic obstructive pulmonary disease (COPD) use a fixed threshold of forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) ratio (<0.70) in post-bronchodilation spirometry to indicate disease, which has been shown to underestimate and overestimate disease prevalence in younger and older adults, respectively, whilst criteria based on reference values have better accuracy. Differences in reference values have limited their use in international studies. However, the new Global Lung Function Initiative reference values (GLI2012) showed FEV/FVC to be the least dependent on ethnicity. The aim of this study was to assess the prevalence of airflow limitation with GLI2012 and the degree of underdetection or overestimation related to the use of GOLD in the general population. A Finnish population sample of 1323 subjects (45% male) with post-bronchodilation spirometry was studied. 80 subjects (6.0%) and 55 subjects (4.2%) were identified with airflow limitation with GOLD and GLI2012 criteria, respectively. The proportion of overestimation with GOLD increased with age from 25% of cases in 50-year-olds to 54% in 70-year-olds. Using z-score-based grading resulted in more dispersion in severity grading. In conclusion, the GOLD criteria cause a marked overestimation already from 50-year-olds and should be replaced with the GLI2012 criteria to improve diagnostic accuracy.
慢性阻塞性肺疾病全球倡议组织（GOLD）的慢性阻塞性肺疾病（COPD）诊断标准采用支气管扩张后肺功能测定中1秒用力呼气容积（FEV）/用力肺活量（FVC）比值的固定阈值（<0.70）来判定疾病，结果显示该标准在年轻和老年成年人中分别低估和高估了疾病患病率，而基于参考值的标准具有更高的准确性。参考值的差异限制了它们在国际研究中的应用。然而，新的全球肺功能倡议参考值（GLI2012）显示FEV/FVC受种族影响最小。本研究的目的是评估使用GLI2012标准时气流受限的患病率以及与使用GOLD标准相关的漏诊或误诊程度。对1323名进行支气管扩张后肺功能测定的芬兰人群样本（45%为男性）进行了研究。分别采用GOLD和GLI2012标准，确定有80名受试者（6.0%）和55名受试者（4.2%）存在气流受限。使用GOLD标准时误诊的比例随年龄增加，从50岁人群中的25%增至70岁人群中的54%。使用基于z评分的分级导致严重程度分级的离散度更大。总之，GOLD标准从50岁起就会导致明显的高估，应被GLI2012标准取代以提高诊断准确性。
