Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
BMJ Open. 2024 Oct 8;14(10):e087687. doi: 10.1136/bmjopen-2024-087687.
Diagnosis and assessment of chronic obstructive pulmonary disease (COPD) rely extensively on spirometry, which necessitates patient cooperation. The clinical value of impulse oscillometry (IOS) as a non-volitional method in patients with COPD remains uncertain.
This retrospective observational study was conducted using patient data from between January 2014 and December 2015.
Five public hospitals in China: West China Hospital, Nuclear Industry 416 Hospital, Suining Central Hospital, Affiliated Hospital, Medical College of Chengdu University and 363 Hospital.
The study included 6307 participants aged>40 years, comprising 2109 COPD patients and 4198 general non-COPD individuals, according to the Global Initiative for Obstructive Lung Disease (GOLD) spirometry standard. Participants with lung cancer, pulmonary tuberculosis, pneumonia or those who underwent lung resection were excluded from the study.
Demographic data, spirometry results and IOS results were collected. Spearman's correlation analysis was used to examine the correlation between the IOS and spirometry parameters. Receiver operating characteristic curve analysis was used to evaluate the IOS performance in COPD diagnosis and severity staging.
Patients with COPD exhibited significant increases in Z5, R5, R20, R5-R20, Fres and Rp, but a decrease in X5 compared with non-COPD subjects (p<0.0001). IOS parameters, including Z5, R5-R20, Fres, Rp and X5, varied with the GOLD stages, with mild-to-moderate correlations with MMEF, forced expiratory volume in one second (FEV)/forced vital capacity and FEV, respectively. However, the combination of these five IOS parameters did not exhibit ideal performance in diagnosing COPD (area under the curve (AUC) 0.78; sensitivity 63.68%; specificity 80.09%), differentiating GOLD stage 1 patients from the general non-COPD population (AUC 0.71; sensitivity 54.71%; specificity 77.49%) or identifying GOLD stages 3 and 4 patients among those with COPD (AUC 0.75; sensitivity 69.51%; specificity 70.32%).
IOS parameters, while showing good correlation with spirometry in patients with COPD, did not perfectly substitute for spirometry in diagnosing COPD, especially in the early and advanced stages of the disease.
慢性阻塞性肺疾病（COPD）的诊断和评估广泛依赖于肺量计，这需要患者的配合。冲动震荡（IOS）作为 COPD 患者的一种非自主方法的临床价值尚不确定。
这是一项回顾性观察性研究，使用了 2014 年 1 月至 2015 年 12 月期间的患者数据。
中国五家公立医院：华西医院、核工业 416 医院、遂宁市中心医院、成都大学附属医院和 363 医院。
根据全球倡议对阻塞性肺病（GOLD）肺量计标准，该研究纳入了 6307 名年龄>40 岁的参与者，包括 2109 例 COPD 患者和 4198 例普通非 COPD 个体。排除患有肺癌、肺结核、肺炎或接受过肺切除术的患者。
收集人口统计学数据、肺量计结果和 IOS 结果。采用 Spearman 相关分析检验 IOS 与肺量计参数之间的相关性。采用受试者工作特征曲线分析评估 IOS 在 COPD 诊断和严重程度分期中的性能。
与非 COPD 患者相比，COPD 患者的 Z5、R5、R20、R5-R20、Fres 和 Rp 显著增加，而 X5 降低（p<0.0001）。IOS 参数（包括 Z5、R5-R20、Fres、Rp 和 X5）随 GOLD 分期而变化，与 MMEE、用力呼气量（FEV）/用力肺活量（FVC）和 FEV 呈轻度至中度相关。然而，这五个 IOS 参数的组合在诊断 COPD 方面表现不佳（曲线下面积（AUC）0.78；敏感性 63.68%；特异性 80.09%），区分 GOLD 1 期患者与普通非 COPD 人群（AUC 0.71；敏感性 54.71%；特异性 77.49%）或识别 COPD 患者中的 GOLD 3 期和 4 期患者（AUC 0.75；敏感性 69.51%；特异性 70.32%）。
在 COPD 患者中，IOS 参数与肺量计具有良好的相关性，但在诊断 COPD 方面不能完全替代肺量计，特别是在疾病的早期和晚期阶段。
