Wei B, Zhang K, Wang Z Y, Fu B H, Huang X M, Chen Y T, Zhao J P, Wang J M, Xie M, Ni W
Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, National Health Commission Key Laboratory of Respiratory Diseases, Hubei Clinical Medical Research Center for Chronic Airway Diseases, Wuhan 430000, China.
Zhonghua Nei Ke Za Zhi. 2024 Nov 1;63(11):1087-1095. doi: 10.3760/cma.j.cn112138-20240410-00231.
To investigate the correlation between impulse oscillometry system examination indicators and conventional pulmonary ventilation function. The pulmonary ventilation function data of 10 883 patients from January 1, 2020 to December 31, 2022 at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were included. The one-second rate [ratio of forced expiratory volume in the first second (FEV) to forced vital capacity (FVC)] measured as a percentage of the predicted value was ≥92% for the control group (3 478) and <92% for the pulmonary obstruction group (7 405). The obstruction group was subdivided into five groups according to the degree of pulmonary dysfunction: mild group (3 938),moderate group (1 142),oderate-severe group (917),severe group (737),and extremely severe group (671). Conventional pulmonary ventilatory function FVC, FEV, one-second rate, and forced expired flow at 50% of FVC (MEF50%), forced expired flow at 75% FVC (MEF25%), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF), and pulsed oscillation pulmonary function test were detected in both groups of patients. Impedance at 5 Hz (Z5) means total respiratory resistance, resistance at 5 Hz (R5) means total airway resistance, reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways, and resistance at 20 Hz (R20) represents resistance of the central airways. R5-R20 reflects resistance in the small airways. Additionally, peripheral resistance (Rp), respiratory resonance frequency (Frex), and area under the reactance curve (Ax) were also measured. Correlation between the indicators of the two groups and the sensitivity and specificity of the impulse oscillometry system parameters for the diagnosis of obstructive pulmonary ventilation dysfunction were analyzed. Pulmonary function force expiratory volume in the first second as a percentage of predicted value (FEV%Pre) [80.10 (54.95,97.10)%],one-second rate [62.43(48.67, 67.02)%],MEF50% [1.33 (0.62,1.97)L/s],MEF25% [0.28 (0.17,0.41)L/s], MMEF [0.85 (0.43,1.29)L/s],and PEF [5.64 (3.73,7.50)]L/s in the obstruction group were significantly lower than those in the control group (0.05). The differences within the subgroups of the obstruction group were also significant (0.05). Pulsed oscillation Z5 [0.42 (0.33,0.55)kPa·L·s],Rp [0.25 (0.20,0.45)kPa·L·s], R5 [0.39 (0.31,0.49)kPa·L·s], R20 [0.28 (0.24,0.34)kPa·L·s], R5-R20 [0.09 (0.05,0.17)kPa·L·s],Frex [16.32 (13.07,20.84)Hz], and Ax [0.67 (0.28,1.64)] indices in the obstruction group were significantly higher than those in the control group. X5 [-0.14 (-0.23, -0.10)kPa·L·s] was significantly lower than that in the control group (0.05). Z5, Rp, X5, R5, R5-R20, Frex, and Ax were statistically significant between different degrees of obstruction in the obstruction group (0.05). The impulse oscillometry system parameters Z5, Rp, R5, R20, R5-20, Frex, and Ax were negatively correlated with the indices of conventional pulmonary ventilation (=-0.21-0.68, 0.05), and the parameter X5 was positively correlated with the indices of conventional pulmonary ventilation (0.41-0.68, 0.05). The pulsed oscillation pulmonary function test parameters X5 (58.60%-95.68%) and Ax (57.08%-98.06%) presented the best sensitivity; X5 (86.29%-98.82%), Frex (86.69%-94.71%), and Ax (88.10%-98.53%) displayed the best specificity; and R20 presented the worst sensitivity and specificity. The sensitivity and specificity were slightly better in female patients than in male patients. The technical parameters of the impulse oscillometry system showed significant correlation with relevant indices of conventional pulmonary ventilation function detection. These well reflect the changes of different degrees of pulmonary ventilation function and have greater significance for reference in evaluating the degree of pulmonary function impairment.
探讨脉冲振荡法检测指标与传统肺通气功能之间的相关性。纳入2020年1月1日至2022年12月31日在华中科技大学同济医学院附属同济医院就诊的10883例患者的肺通气功能数据。对照组(3478例)的一秒率[第一秒用力呼气容积(FEV)与用力肺活量(FVC)之比]占预计值的百分比≥92%,肺阻塞组(7405例)<92%。阻塞组根据肺功能障碍程度分为五组:轻度组(3938例)、中度组(1142例)、中重度组(917例)、重度组(737例)和极重度组(671例)。对两组患者进行传统肺通气功能FVC、FEV、一秒率、FVC 50%时的用力呼气流量(MEF50%)、FVC 75%时的用力呼气流量(MEF25%)、最大呼气中期流量(MMEF)、呼气峰值流量(PEF)以及脉冲振荡肺功能测试。5Hz时的阻抗(Z5)表示总呼吸阻力,5Hz时的阻力(R5)表示总气道阻力,5Hz时的电抗(X5)表示外周气道的弹性回缩力,20Hz时的阻力(R20)代表中央气道阻力。R5-R20反映小气道阻力。此外,还测量了外周阻力(Rp)、呼吸共振频率(Frex)和电抗曲线下面积(Ax)。分析两组指标之间的相关性以及脉冲振荡法系统参数对阻塞性肺通气功能障碍诊断的敏感性和特异性。阻塞组的第一秒用力呼气容积占预计值百分比(FEV%Pre)[80.10(54.95,97.10)%]、一秒率[62.43(48.67,67.02)%]、MEF50%[1.33(0.62,1.97)L/s]、MEF25%[0.28(0.17,0.41)L/s]、MMEF[0.85(0.43,1.29)L/s]和PEF[5.64(3.73,7.50)]L/s均显著低于对照组(P<0.05)。阻塞组各亚组之间的差异也有统计学意义(P<0.05)。阻塞组的脉冲振荡Z5[0.42(0.33,0.55)kPa·L·s]、Rp[0.25(0.20,0.45)kPa·L·s]、R5[0.39(0.31,0.49)kPa·L·s]、R20[0.28(0.24,0.34)kPa·L·s]、R5-R20[0.09(0.05,0.17)kPa·L·s]、Frex[16.32(13.07,20.84)Hz]和Ax[0.67(0.28,1.64)]指标均显著高于对照组。X5[-0.14(-0.23,-0.10)kPa·L·s]显著低于对照组(P<0.05)。阻塞组不同阻塞程度之间的Z5、Rp、X5、R5、R5-R20、Frex和Ax差异有统计学意义(P<0.05)。脉冲振荡法系统参数Z5、Rp、R5、R20、R5-20、Frex和Ax与传统肺通气指标呈负相关(r=-0.21~-0.68,P<0.05),参数X5与传统肺通气指标呈正相关(r=0.41~0.68,P<0.05)。脉冲振荡肺功能测试参数X5(58.60%~95.68%)和Ax(57.08%~98.06%)的敏感性最佳;X5(86.29%~98.82%)、Frex(86.69%~94.71%)和Ax(88.10%~98.53%)的特异性最佳;R20的敏感性和特异性最差。女性患者的敏感性和特异性略优于男性患者。脉冲振荡法系统技术参数与传统肺通气功能检测的相关指标具有显著相关性。这些参数能很好地反映不同程度肺通气功能的变化,对评估肺功能损害程度具有较大的参考意义。