Mou Ting, Wang Yujiao, Fu Yufen, Wang Yuxin, Li Guoping
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
Department of Respiratory and Critical Care Medicine, Chengdu Third People's Hospital Branch of National Clinical Research Center for Respiratory Disease, Chengdu, Sichuan, 610031, China.
BMC Pulm Med. 2024 Dec 18;24(1):619. doi: 10.1186/s12890-024-03420-z.
Currently, there has been no gold standard for diagnosing small airway dysfunction (SAdf). This study aimed to evaluate the correlation between small airway parameters derived from spirometry and oscillometry in hospitalized patients, assessing the potential of oscillometry as an alternative diagnostic tool for SAdf. Additionally, this study explored the inconsistencies and influencing factors related to spirometry and oscillometry in diagnosing SAdf, conducting a preliminary assessment of these factors.
A retrospective study was conducted involving data collection from patients who underwent both spirometry and oscillometry between June 1, 2022, and September 1, 2023, at Chengdu Third People's Hospital was conducted. Initially, 1,771 patients were considered, with 1,446 meeting the inclusion and exclusion criteria. The clinical characteristics and correlations between small airway parameters from the two methods were analyzed based on different lung function data groups. Besides, this study explored the inconsistency between the two pulmonary function tests in diagnosing SAdf in hospitalized patients. Multivariate logistic regression was employed to investigate the factors contributing to these inconsistencies.
Significant correlations were identified between parameters (reactance area [AX], resonant frequency [Fres], reactance at 5 Hz [X5], difference between resistance at 5 Hz and R20 [R5-R20]) and the forced expiratory flow (FEF) metrics (FEF25%-75%, FEF50%, and FEF75%). Among these, AX showed the strongest correlation, regardless of the severity of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and the FEV1/FVC ratio. Diagnostic inconsistencies were influenced by factors such as sex, body mass index (BMI), and sputum production. Females, individuals with a high BMI, and those with less sputum were linked to oscillometry-only SAdf, while males, individuals with alow BMI, and those with more sputum were linked to spirometry-only SAdf.
In hospitalized patients, oscillometry could serve as an effective alternative or complement to spirometry for diagnosing SAdf. A greater degree of lung function impairment was correlated with small airway parameters between the two tests. The oscillometry might detect SAdf more sensitively in patients with normal pulmonary function as measured by spirometry. Ultimately, we recommend the combined use of spirometry and oscillometry in hospitalized patients based on its comprehensive assessment of small airway function and potential in timely intervention.
目前，小气道功能障碍（SAdf）尚无金标准诊断方法。本研究旨在评估住院患者通过肺量计和振荡法得出的小气道参数之间的相关性，评估振荡法作为SAdf替代诊断工具的潜力。此外，本研究探讨了肺量计和振荡法在诊断SAdf方面的不一致性及影响因素，并对这些因素进行了初步评估。
进行一项回顾性研究，收集2022年6月1日至2023年9月1日在成都市第三人民医院同时接受肺量计和振荡法检查的患者数据。最初考虑了1771例患者，其中1446例符合纳入和排除标准。根据不同的肺功能数据组分析两种方法的小气道参数的临床特征及相关性。此外，本研究探讨了两种肺功能测试在诊断住院患者SAdf方面的不一致性。采用多因素逻辑回归分析导致这些不一致性的因素。
参数（电抗面积[AX]、共振频率[Fres]、5Hz时的电抗[X5]、5Hz时的阻力与R20之间的差值[R5-R20]）与用力呼气流量（FEF）指标（FEF25%-75%、FEF50%和FEF75%）之间存在显著相关性。其中，AX的相关性最强，无论用力肺活量（FVC）、第一秒用力呼气量（FEV1）及FEV1/FVC比值的严重程度如何。诊断不一致性受性别、体重指数（BMI）和痰液产生等因素影响。女性、BMI高的个体以及痰液少的个体与仅通过振荡法诊断的SAdf相关，而男性、BMI低的个体以及痰液多的个体与仅通过肺量计诊断的SAdf相关。
在住院患者中，振荡法可作为肺量计诊断SAdf的有效替代方法或补充方法。两种测试之间，更高程度的肺功能损害与小气道参数相关。振荡法可能在通过肺量计测量的肺功能正常的患者中更敏感地检测出SAdf。最终，基于其对小气道功能的全面评估及及时干预的潜力，我们建议在住院患者中联合使用肺量计和振荡法。
