CAJ | 학술논문

目的了解肺功能检测在农村社区的应用现状及其对慢性阻塞性肺疾病(COPD)社区诊断的影响.方法以北京市怀柔区桥梓镇社区卫生服务中心管辖的60岁以上的老年人口为研究对象开展横断面调查,经整群随机抽样,对4个行政村共708名进行问卷调查和肺功能检测.支气管舒张试验后第一秒用力呼气容积/用力肺活量(FEV1/FVC)＜ 70％者,行COPD确诊.结果确诊COPD患者96例,COPD患病率为13.56％(95％ CI:11.04％～ 14.08％),但其中仅有8例(8/96,8.33％)曾经接受过肺功能检测;708名老人中仅有34名(4.80％)曾经接受过肺功能检测.对可能影响既往接受过肺功能检测的因素进行多元logistic回归分析,显示有支气管炎病史者更倾向于主动寻求肺功能检测,OR值及其95％ CI为5.39(2.20 ～ 13.19).对COPD患者与对照人群的logistic回归分析则显示,年龄、吸烟(累积吸烟超过100支或5包)以及喘息发作的OR值及其95％ CI分别为1.32(1.11 ～1.57)、2.12(1.17 ～3.84)和6.57(3.30～13.10).结论我国农村社区肺功能检测应用严重不足,导致老年人中的COPD在社区慢性病管理中被漏诊.建议社区医生对于老年人群,吸烟者和有喘息发作者给予足够重视,有针对性开展肺功能检测,早期诊断COPD,并加强对其管理.
목적 료해폐공능검측재농촌사구적응용현상급기대만성조새성폐질병(COPD)사구진단적영향.방법 이북경시부유구교재진사구위생복무중심관할적60세이상적노년인구위연구대상개전횡단면조사,경정군수궤추양,대4개행정촌공708명진행문권조사화폐공능검측.지기관서장시험후제일초용력호기용적/용력폐활량(FEV1/FVC)＜ 70％자,행COPD학진.결과 학진COPD환자96례,COPD환병솔위13.56％(95％ CI:11.04％～ 14.08％),단기중부유8례(8/96,8.33％)증경접수과폐공능검측;708명노인중부유34명(4.80％)증경접수과폐공능검측.대가능영향기왕접수과폐공능검측적인소진행다원logistic회귀분석,현시유지기관염병사자경경향우주동심구폐공능검측,OR치급기95％ CI위5.39(2.20 ～ 13.19).대COPD환자여대조인군적logistic회귀분석칙현시,년령、흡연(루적흡연초과100지혹5포)이급천식발작적OR치급기95％ CI분별위1.32(1.11 ～1.57)、2.12(1.17 ～3.84)화6.57(3.30～13.10).결론 아국농촌사구폐공능검측응용엄중불족,도치노년인중적COPD재사구만성병관리중피루진.건의사구의생대우노년인군,흡연자화유천식발작자급여족구중시,유침대성개전폐공능검측,조기진단COPD,병가강대기관리.
Objective To survey the under-using status of spirometry in rural community and assess its impact on the missed diagnosis of chronic obstructive pulmonary disease (COPD).Methods A total of 708 participants aged 60 years or more were sampled by cluster random sampling from 4 administrative villages in Qiaozi,Huairou,Beijing in this cross-sectional study.Questionnaire survey and spirometry were performed to each person.Patients with FEV1/FVC ＜ 70％ were further diagnosed as COPD.Results 96 patients were diagnosed as COPD and the rude prevalence of COPD was 13.56％ (95％ CI:11.04％-14.08％)among elder people aged 60 years or more in rural community.However,only 8 of 96 patients with COPD (8.33％) have been acquired spirometry.Among 708 participants,only 34 patients (4.80％) have been checked by spirometry.The multivariate logistic regression analysis was conducted to explore the potential cause of taking spirometry which showed patients with bronchitis were more inclined to seek spirometry (OR:5.39 ; its 95％ CI:2.20-13.19).The results of multivariate logistic regression analysis to explore the potential diagnostic indices of COPD showed age,smoking(the cumulative amount was more than 100 cigarettes or 5 packages) and wheezing was statistically significant.Conclusions The underuse of spirometry in rural community of China results in the missed diagnosis of COPD in community.It was suggested that general practitioners should advise the elderly smokers with wheezing to acquire spirometry in the community timely or referral to hospital so that patients with COPD could be diagnosed earlier and be managed.