Zhang J X, Liu C H, Li S, Song X
Department of Allergy, Children's Hospital of Capital Institute of Pediatrics, Beijing 100020, China.
Zhonghua Er Ke Za Zhi. 2020 Feb 2;58(2):140-144. doi: 10.3760/cma.j.issn.0578-1310.2020.02.014.
To explore the cutoff value of FEV(1)/FVC for evaluating obstructive ventilation dysfunction in children. Three hundred and eighty-three healthy children (190 boys and 193 girls) aged 6-14 years in primary and middle school in Beijing, who were enrolled from May 2010 to June 2011, had their spirometry done with the Jaeger lung function instrument, and the lower limit of normal (LLN) of FEV(1)/FVC was calculated. Two hundred and thirteen asthmatic children (151 boys and 62 girls) aged 6-14 years from the outpatient Department of Allergy, Capital Institute of Pediatrics were enrolled consecutively from June to July 2018, whose clinical history and pulmonary function parameters were collected. The expected value of spirometric parameters of asthmatic children was calculated according to Zapletal prediction equations. And the LLN of FEV(1)/FVC in healthy children was used as the gold standard to calculate the sensitivity, specificity, Youden index and Kappa value of FEV(1)/FVC<80% and FEV(1)/FVC< 92% predicted. In healthy children, the FEV(1)/FVC and the LLN were 91%±5% and 82% respectively, while 90%±6% and 81% in boys, and 92%±5% and 84% in girls. There were 27 (12.7%) asthmatic children whose FEV(1)/FVC<80% but FEV(1)/FVC≥92% predicted (χ(2)=123.7, 0.01). The sensitivity, specificity, Youden index and Kappa value of FEV(1)/FVC<80% were 80.3%, 100%, 0.803 and 0.787 respectively when FEV(1)/FVC<80% was used as the criteria to assess lung function, while they were 57.3%, 100%, 0.573 and 0.547, respectively, when FEV(1)/FVC<92% predicted was used as criteria. The 80% of FEV(1)/FVC has a better consistency with the LLN of FEV(1)/FVC than 92% of FEV(1)/FVC% predicted. It is more accarate to use FEV(1)/FVC<80% as the diagnostic criteria for airway obstruction.
探讨用于评估儿童阻塞性通气功能障碍的FEV(1)/FVC的临界值。2010年5月至2011年6月选取了北京市383名6 - 14岁的中小学生健康儿童（190名男孩和193名女孩），使用耶格肺功能仪进行肺功能检测，并计算FEV(1)/FVC的正常下限（LLN）。2018年6月至7月连续纳入首都儿科研究所过敏门诊的213名6 - 14岁哮喘儿童，收集其临床病史和肺功能参数。根据扎普莱塔尔预测方程计算哮喘儿童肺功能参数的预期值。以健康儿童FEV(1)/FVC的LLN作为金标准，计算FEV(1)/FVC<80%和FEV(1)/FVC<预测值的92%时的敏感度、特异度、约登指数和kappa值。在健康儿童中，FEV(1)/FVC和LLN分别为91%±5%和82%，男孩分别为90%±6%和81%，女孩分别为92%±5%和84%。有27名（12.7%）哮喘儿童FEV(1)/FVC<80%但FEV(1)/FVC≥预测值的92%（χ(2)=123.7，P<0.01）。以FEV(1)/FVC<80%作为评估肺功能的标准时，FEV(1)/FVC<80%的敏感度、特异度、约登指数和kappa值分别为80.3%、100%、0.803和0.787，而以FEV(1)/FVC<预测值的92%作为标准时，分别为57.3%、100%、0.573和0.547。FEV(1)/FVC的80%与FEV(1)/FVC的LLN的一致性优于FEV(1)/FVC%预测值的92%。以FEV(1)/FVC<80%作为气道阻塞的诊断标准更准确。
