Zacharasiewicz Angela, Renner Sabine, Haderer Flora, Weber Michael, Dehlink Eleonore, Szepfalusi Zsolt, Frischer Thomas
Department of Pediatrics and Adolescent Medicine, Wilhelminenspital Vienna, Montleartstrasse 37, 1160, Vienna, Austria.
Department of Pediatrics, Medical University Hospital Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2017 Aug;129(15-16):533-539. doi: 10.1007/s00508-017-1184-0. Epub 2017 Mar 9.
Interpretation of lung function values in children with cystic fibrosis (CF) depends on the applied reference values. We hypothesize that differences between the new global lung function initiative (GLI) values and the formerly used Zapletal et al. values produce significantly different clinical results. We analyzed 3719 lung function measurements of 108 children and adolescents (n = 54 male; aged 6-18 years) with CF treated between September 1991 and July 2009. Data were analyzed in milliliters (ml) and % predicted (pred.) and interpreted using Zapletal and GLI reference values. Applying GLI compared to Zapletal resulted in significantly lower mean forced expiratory volume in 1s (FEV1)% pred.
Zapletal 86.6% (SD 20.6), GLI 79.9% (SD 20.3) and 32% (n = 497/1543) were misclassified as normal when using Zapletal. Despite showing no overall differences in FEV1 and forced vital capacity (FVC) between concomitant Pseudomonas detection (PA+) in n = 938 and Pseudomonas negative (PA-) (n = 2781) using either reference PA+ resulted in lower FEV1 and FVC values with increasing age; however, measurement of small airway obstruction with forced expiratory flow at 75% of FVC (FEF75) values - available for Zapletal -showed significant differences. Reassurance regarding lung function when using old reference values may occur with potential clinical significance. Discrepancies in lung function interpretation underline the importance of using uniform and best available reference values.
囊性纤维化（CF）患儿肺功能值的解读取决于所应用的参考值。我们假设，新的全球肺功能倡议（GLI）值与先前使用的扎普莱塔尔等人的值之间的差异会产生显著不同的临床结果。我们分析了1991年9月至2009年7月期间接受治疗的108名儿童和青少年（n = 54名男性；年龄6 - 18岁）的3719次肺功能测量数据。数据以毫升（ml）和预测值百分比（pred.）进行分析，并使用扎普莱塔尔和GLI参考值进行解读。与扎普莱塔尔参考值相比，应用GLI参考值时，1秒用力呼气容积（FEV1）预测值百分比的平均数值显著更低。
使用扎普莱塔尔参考值时，86.6%（标准差20.6）、GLI为79.9%（标准差20.3）以及32%（n = 497/1543）被误分类为正常。尽管在n = 938例检测到铜绿假单胞菌（PA +）和n = 2781例铜绿假单胞菌阴性（PA -）的患者中，使用任一参考值时FEV1和用力肺活量（FVC）总体上无差异，但PA +患者的FEV1和FVC值随年龄增长而降低；然而，对于扎普莱塔尔参考值可获取的以FVC的75%用力呼气流量（FEF75）值来测量小气道阻塞情况，显示出显著差异。使用旧参考值时对肺功能的放心可能具有潜在临床意义。肺功能解读的差异凸显了使用统一且最佳可用参考值的重要性。
