Brändli O, Schindler C, Künzli N, Keller R, Perruchoud A P
Zürcher Höhenklinik Wald, Faltigberg, Switzerland.
Thorax. 1996 Mar;51(3):277-83. doi: 10.1136/thx.51.3.277.
Reference values and definitions of "normal" are prerequisites for population screening and classification of lung diseases. The aim of this study was to calculate reference values for never smoking Caucasian adults.
In the SAPALDIA cross sectional study respiratory health was assessed in a random sample of 9651 subjects, aged 18-60 years, from eight areas of Switzerland. Lung function was measured according to ATS criteria including quality control. In 3157 healthy never smoking adults without respiratory symptoms the mean values and fifth percentiles of lung function variables were calculated. For each sex, logarithms of lung function were regressed against age, age squared, and the logarithm of height. Residuals were used to estimate fifth percentiles across the age range using a technique not requiring normality or homoscedasticity of residuals.
Most lung function variables were non-linear with age and showed an increase in early adulthood and an accelerated decline thereafter. The reference values for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were higher than those of the European Community for Coal and Steel and those from North America. The prediction equations for lower fifth percentile values defined a stable proportion of subjects outside this limit whereas alternative methods for estimating the fifth percentile showed a loss of sensitivity with age.
The reference equations for mean values of spirometric indices and their lower fifth percentiles gave an improved and unbiased lower limit of normal. The higher mean values may in part be due to the strictly selected population, quality control procedures, cohort effects, and altitude, and are not explained by the statistical model used.
“正常”的参考值和定义是人群肺部疾病筛查和分类的前提条件。本研究的目的是计算从不吸烟的白种成年人的参考值。
在SAPALDIA横断面研究中，对来自瑞士八个地区的9651名年龄在18至60岁之间的受试者进行了随机抽样，评估其呼吸健康状况。根据美国胸科学会（ATS）标准测量肺功能，包括质量控制。在3157名无呼吸系统症状的健康从不吸烟成年人中，计算肺功能变量的平均值和第五百分位数。对于每一种性别，将肺功能的对数与年龄、年龄的平方以及身高的对数进行回归分析。使用一种不需要残差呈正态分布或同方差性的技术，通过残差来估计整个年龄范围内的第五百分位数。
大多数肺功能变量与年龄呈非线性关系，在成年早期增加，此后下降加速。用力肺活量（FVC）和一秒用力呼气容积（FEV1）的参考值高于欧洲煤钢共同体和北美的参考值。较低第五百分位数的预测方程定义了超出此限值的受试者的稳定比例，而估计第五百分位数的其他方法则显示出随年龄增长敏感性降低。
肺量计指标平均值及其较低第五百分位数的参考方程给出了改进的、无偏的正常下限。较高的平均值部分可能归因于严格挑选的人群、质量控制程序、队列效应和海拔高度，而不能用所使用的统计模型来解释。
