肺功能检查在慢性阻塞性肺疾病早期诊断和临床评价中作用的探讨

发布时间：2018-06-03 19:17

  本文选题：慢性阻塞性肺疾病 + 肺功能　； 参考：《吉林大学》2016年硕士论文

【摘要】：背景:慢性阻塞性肺疾病(Chronic obstructive pulmonary diseases,COPD)是“十三五”规划全国重点防治的四大慢性疾病之一,肺功能进行性下降是是其主要诊断及评价依据。全球COPD防治创议(Global initiative for chronic obstructive lung diseases,GOLD)指南强调任何考虑可能患有COPD的患者均应进行肺功能检查。目的:通过对COPD患病率、诊断率、漏诊率、吸烟对肺功能的影响、COPD存在合并症时肺功能变化的研究,探讨肺功能检查在COPD患者早期诊断和临床评价中的作用。方法:采用整群随机抽样调查方法,共调查年龄≥40周岁的长春市社区居民1393人,对所有调查对象进行COPD调查问卷和肺功能检查。问卷内容包括调查对象的基本信息、COPD相关的高危因素、既往史等情况。肺功能检查方法及质控标准参照2014年肺功能检查指南。结果:1.本次筛查共确诊COPD患者176人,患病率为12.64%。漏诊患者共160人,漏诊率为90.91%。曾明确诊断为COPD共有16人,诊断率为9.09%。2.吸烟人群中COPD患病率为20.71%,明显高于非吸烟人群的患病率8.8%(P0.05)。COPD吸烟组中吸烟指数与肺功能各指标呈显著负相关,即随着吸烟指数的增加,肺功能各指标呈降低趋势。3.与单纯COPD组相比,COPD有合并症组肺功能各项指标均明显偏低,而健康组和非COPD患病组两组间肺功能指标无明显差异。4.与COPD有1种合并症组相比,COPD有2种合并症组肺功能各项指标虽偏低,但无统计学差异(P0.05),而COPD有≥3种合并症组肺功能指标均明显偏低,差异具有统计学意义。5.与单纯COPD组相比,COPD合并哮喘组肺功能指标除FVC%外,均明显偏低,差异具有统计学意义。COPD合并CVD组肺功能指标除PEF%、FEF75%外均明显低于单纯COPD组,差异具有统计学意义。COPD合并糖尿病组和单纯COPD组两组间肺功能未发现明显差异。6.支气管哮喘和心血管疾病(高血压、冠心病)是COPD发病的危险因素。结论:1.长春地区40周岁以上社区居民COPD患病率及漏诊率均较高,肺功能检查在COPD早期诊断中起着至关重要的作用。2.吸烟人群中COPD患病率明显高于非吸烟人群的患病率。COPD吸烟患者吸烟量越大,肺功能损害越重。3.与单纯COPD患者相比,COPD患者存在合并症时肺功能损害更为严重,并且随着合并症数目的增多,肺功能下降程度也会增加。4.支气管哮喘和心血管疾病(高血压、冠心病)是COPD发病的危险因素。
[Abstract]:Background: chronic obstructive pulmonary disease (CP) is one of the four major chronic diseases in the 13th Five-Year Plan. Progressive decline of pulmonary function is the main basis for its diagnosis and evaluation. The Global initiative for chronic obstructive lung Disease guidelines for Global initiative for chronic obstructive lung Disease (COPD) emphasize that any patient who considers possible COPD should undergo a pulmonary function test. Objective: to explore the role of pulmonary function examination in the early diagnosis and clinical evaluation of COPD patients by studying the effects of COPD prevalence, diagnostic rate, missed diagnosis rate and smoking on pulmonary function. Methods: a total of 1393 community residents aged more than 40 years were investigated by cluster random sampling. All the subjects were investigated by COPD questionnaire and pulmonary function test. The questionnaire included basic information about COPD related high-risk factors, past history and so on. Lung function test methods and quality control standards refer to the 2014 lung function test guidelines. The result is 1: 1. A total of 176 patients with COPD were diagnosed by this screening, and the prevalence rate was 12.64. There were 160 patients with missed diagnosis, and the missed diagnosis rate was 90.91%. A total of 16 patients were diagnosed with COPD, and the diagnostic rate was 9.09. 2. The prevalence rate of COPD in smoking population was 20.71, which was significantly higher than that in non-smoking population. The smoking index in 8.8%(P0.05).COPD smoking group was negatively correlated with the pulmonary function index, that is, with the increase of smoking index, the pulmonary function index showed a decreasing trend. Compared with the simple COPD group, the pulmonary function indexes were significantly lower in the patients with COPD, but there was no significant difference between the healthy group and the non-COPD group. 4. Compared with the group with one complication of COPD, the indexes of pulmonary function in the patients with COPD were lower, but there was no statistical difference between them (P 0.05), while the indexes of pulmonary function in the patients with COPD 鈮，

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