Centre de Ressources et de Compétences de la Mucoviscidose, Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, Tours, France.
Faculty of Sport Sciences, Movement-Interactions-Performance, MIP, Université de Nantes, Nantes, France.
Clin Physiol Funct Imaging. 2021 Jan;41(1):76-84. doi: 10.1111/cpf.12668. Epub 2020 Oct 23.
Diagnosis of acute exacerbation (AE) of cystic fibrosis (CF) must be precise because both under- and over-prescription of antibiotics may be detrimental. How lung function tests contribute to diagnose AE is unclear. We aimed to describe variation of spirometry and oscillometry measurements, at Stable state and at AE in adults with CF.
Patients were included in a retrospective single-centre study when both spirometry (FEV1, FVC) and oscillometry (X5, R5, R5-R20 and AX) data were available for at least one Stable and one AE visit between December 2016 and July 2019. For each visit, we calculated variation (Δ) in spirometry and oscillometry indices in comparison with personal best values. Measurements were expressed as % of predicted values and Z-scores when applicable. Areas under ROC curves (AUC) were computed.
Forty-two patients (28 ± 9 years, FEV1 64 ± 21%) were included; 80 AE and 104 Stable visits were analysed. FEV1 (L, %pred and Z-score) and FVC (%pred and Z-score) varied significantly between AE and Stable visits (p < .05), although differences were small (80 ml/2.7%pred for FEV1). Among oscillometry indices, X5 (kPa.s.L ), R5-R20 (kPa.s.L ) and AX (kPa/L) varied significantly. The AUCs for the variation in spirometry indices ranged from 0.601 (ΔFVC L) to 0.635 (ΔFEV1%pred). They were not significantly different from the AUCs for ΔX5 (0.589), ΔR5-R20 (0.649) and ΔAX (0.598).
Performance of both spirometry and oscillometry to discriminate AE from Stable state was poor. Variation of oscillometry indices (X5, R5-R20, AX) may be helpful when spirometry is unreliable or uncomfortable.
囊性纤维化（CF）急性加重（AE）的诊断必须准确，因为抗生素的使用不足或过度都可能有害。肺功能测试在诊断 AE 中的作用尚不清楚。我们旨在描述 CF 成人在稳定期和 AE 时的肺活量测定和振荡测量的变化。
当 2016 年 12 月至 2019 年 7 月期间至少有一次稳定期和一次 AE 就诊时，患者同时有肺活量测定（FEV1、FVC）和振荡测量（X5、R5、R5-R20 和 AX）数据时，我们将其纳入回顾性单中心研究。对于每个就诊，我们计算了与个人最佳值相比的肺活量和振荡测量指数的变化（Δ）。测量值以预测值的百分比和适用时的 Z 分数表示。计算了 ROC 曲线下面积（AUC）。
纳入了 42 名患者（28 ± 9 岁，FEV1 64 ± 21%）；分析了 80 次 AE 和 104 次稳定就诊。FEV1（L、%pred 和 Z 分数）和 FVC（%pred 和 Z 分数）在 AE 和稳定就诊之间差异有统计学意义（p <.05），尽管差异较小（FEV1 为 80ml/2.7%pred）。在振荡测量指数中，X5（kPa.s.L）、R5-R20（kPa.s.L）和 AX（kPa/L）差异有统计学意义。肺活量测定指数变化的 AUC 范围为 0.601（ΔFVC L）至 0.635（ΔFEV1%pred）。它们与ΔX5（0.589）、ΔR5-R20（0.649）和ΔAX（0.598）的 AUC 无显著差异。
无论是肺活量测定还是振荡测量，对区分 AE 与稳定期的性能均不佳。当肺功能不可靠或不舒服时，振荡测量指数（X5、R5-R20、AX）的变化可能有帮助。
