Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2018 May 5;131(9):1016-1022. doi: 10.4103/0366-6999.227840.
The interpretation of spirometry varies on different reference values. Older people are usually underrepresented in published predictive values. This study aimed at developing spirometric reference equations for elderly Chinese in Jinan aged 60-84 years and to compare them to previous equations.
The project covered all of Jinan city, and the recruitment period lasted 9 months from January 1, 2017 to September 30, 2017, 434 healthy people aged 60-84 years who had never smoked (226 females and 208 males) were recruited to undergo spirometry. Vital capacity (VC), forced VC (FVC), forced expiratory volume in 1 s (FEV), FEV/FVC, FEV/VC, FEV, peak expiratory flow, and forced expiratory flow at 25%, 50%, 75%, and 25-75% of FVC exhaled (FEF, FEF, FEF, and FEF) were analyzed. Reference equations for mean and the lower limit of normal (LLN) were derived using the lambda-mu-sigma method. Comparisons between new and previous equations were performed by paired t-test.
New reference equations were developed from the sample. The LLN of FEV/FVC, FEFcomputed using the 2012-Global Lung Function Initiative (GLI) and 2006-Hong Kong equations were both lower than the new equations. The biggest degree of difference for FEV/FVC was 19% (70.46% vs. 59.29%, t = 33.954, P < 0.01) and for maximal midexpiratory flow (MMEF, equals to FEF) was 22% (0.82 vs. 0.67, t = 21.303, P < 0.01). The 1990-North China and 2009-North China equations predicted higher mean values of FEV/FVC and FEFthan the present model. The biggest degrees of difference were -4% (78.31% vs. 81.27%, t = -85.359, P < 0.01) and -60% (2.11 vs. 4.68, t = -170.287, P < 0.01), respectively.
The newly developed spirometric reference equations are applicable to elderly Chinese in Jinan. The 2012-GLI and 2006-Hong Kong equations may lead to missed diagnoses of obstructive ventilatory defects and the small airway dysfunction, while traditional linear equations for all ages may lead to overdiagnosis.
不同的参考值会影响肺量计的解读。已发表的预测值中通常较少包括老年人。本研究旨在为济南 60-84 岁的老年人制定肺量计参考方程，并与以往的方程进行比较。
该项目覆盖了整个济南市，招募期从 2017 年 1 月 1 日至 2017 年 9 月 30 日，共招募了 434 名从未吸烟的 60-84 岁健康人（226 名女性和 208 名男性）进行肺量计检查。分析肺活量（VC）、用力肺活量（FVC）、一秒用力呼气量（FEV）、FEV/FVC、FEV/VC、FEV、呼气峰流速和用力呼出 25%、50%、75%和 25-75%肺活量时的呼气流速（FEF、FEF、FEF 和 FEF）。使用 lambda-mu-sigma 方法得出均值和下限正常（LLN）的参考方程。使用配对 t 检验比较新方程和旧方程。
从样本中得出了新的参考方程。使用 2012 年全球肺功能倡议（GLI）和 2006 年香港方程计算得出的 FEV/FVC 和 FEF 的 LLN 均低于新方程。FEV/FVC 的最大差异为 19%（70.46%比 59.29%，t=33.954，P<0.01），最大呼气流速（等于 FEF）的最大差异为 22%（0.82 比 0.67，t=21.303，P<0.01）。1990 年华北和 2009 年华北方程预测的 FEV/FVC 和 FEF 均值高于本模型。最大差异分别为-4%（78.31%比 81.27%，t=-85.359，P<0.01）和-60%（2.11 比 4.68，t=-170.287，P<0.01）。
新制定的肺量计参考方程适用于济南的老年人。2012 年 GLI 和 2006 年香港方程可能导致阻塞性通气功能障碍和小气道功能障碍的漏诊，而所有年龄段的传统线性方程可能导致过度诊断。
