CAJ | 학술논문

目的探讨从高危人群中筛查COPD患者的效率.对单独或联合筛查方法诊断COPD的敏感度、特异度和町靠性进行评估.方法 2003年1-7月对241例自愿接受检查者进行筛查,筛查对象均为40岁以上且必须符合以下标准之一:慢性咳嗽和咳痰、活动后气短和长期大量吸烟史(吸烟量>10包年).由固定的呼吸科医生询问病史,进行体格检查,拍摄X线胸片,测定肺通气功能,进行支气管舒张试验.多组均数之间的比较采用方差分析,组间两两比较采用t检验.从灵敏度、特异度等方面评价临床表现、单独和联合危险因素指标诊断COPD的价值.结果在241例COPD高危人群中,肺功能检查符合COPD者156例(64.7%),其中126例为首次诊断病例,占全部筛查者的52.3%;轻、中度COPD患者87例(36.1%),重度和极重度COPD患者69例(28.6%).在单因素筛查中,以活动后气短筛查COPD的灵敏度为61.5%,特异度为61.2%.40岁以上且有重度吸烟、慢性咳嗽和咳痰及活动后气短3项之一者,筛查诊断的灵敏度均达到90%以上.结论对高危人群进行肺功能筛查是方便、快捷的筛查方法,可以提高COPD的早期诊断水平.以临床表现和危险因素联合筛查可以提高COPD诊断的灵敏度和特异度.临床上可以根据筛查的不同目的选用适宜的联合筛查方法.
목적 탐토종고위인군중사사COPD환자적효솔.대단독혹연합사사방법진단COPD적민감도、특이도화정고성진행평고.방법 2003년1-7월대241례자원접수검사자진행사사,사사대상균위40세이상차필수부합이하표준지일:만성해수화해담、활동후기단화장기대량흡연사(흡연량>10포년).유고정적호흡과의생순문병사,진행체격검사,박섭X선흉편,측정폐통기공능,진행지기관서장시험.다조균수지간적비교채용방차분석,조간량량비교채용t검험.종령민도、특이도등방면평개림상표현、단독화연합위험인소지표진단COPD적개치.결과 재241례COPD고위인군중,폐공능검사부합COPD자156례(64.7%),기중126례위수차진단병례,점전부사사자적52.3%;경、중도COPD환자87례(36.1%),중도화겁중도COPD환자69례(28.6%).재단인소사사중,이활동후기단사사COPD적령민도위61.5%,특이도위61.2%.40세이상차유중도흡연、만성해수화해담급활동후기단3항지일자,사사진단적령민도균체도90%이상.결론 대고위인군진행폐공능사사시방편、쾌첩적사사방법,가이제고COPD적조기진단수평.이림상표현화위험인소연합사사가이제고COPD진단적령민도화특이도.림상상가이근거사사적불동목적 선용괄의적연합사사방법.
Objective To investigate the results of spirometry testing used in the screening of COPD from at risk populations. Methods A survey of the population aged over 40 years with any of chronic cough and sputum, dyspnea, heavy tobacco smoke was performed, using a questionnaire on clinical characteristics of COPD. Spirometry and chest X ray examination were performed. Different screening methods were compared for sensitivity and specificity for COPD diagnosis. Results Of 241 surveyed persons, 156 were diagnosed as having COPD, among whom 126 cases were firstly diagnosed. Among all surveyed persons, 87 (36.1%) cases had mild and moderate COPD, while 69 (28.6%) had severe and very severe disease. The sensitivity and specificity for diagnosis of COPD of shortness of breath were 61.5% and 61.2% respectively. Combination of respiratory symptoms and risk factors improved the screening power. More than 40 years of age combined with any of heavy smoking, chronic cough and sputum, or shortness of breath, improved the sensitivity to more than 90 percent. Conclusions Spirometry test screening of the at risk population can effectively improve early diagnosis of COPD.