怎样定义哮喘患者的气流阻塞？
2009/11/17
全球哮喘防治创议（GINA）及美国国家心脏、肺和血液研究所制定的哮喘防治指南中关于气流阻塞的定义不一致，分别表述为固定的第一秒用力呼气量（FEV1）/用力肺活量（FVC）截值点和正常下限值（LLN）。最近，美国胸科协会和欧洲呼吸协会推荐在肺功能检测中采用LLN。采用固定截值点的主要问题在于将其固定为某个值，而不管患者性别和年龄，虽然简化了诊断，但有出现误诊和漏诊的可能性。对欧洲共同体呼吸健康调查研究中的815名哮喘患者（年龄20～44岁）采用固定FEV1/FVC比值（0.70，0.75和0.80）及LLN评价其敏感性和特异性。对于男性患者，比值为0.70时敏感性为76.5%，特异性为100.0%；比值为0.75时，敏感性为100.0%，特异性为92.4%；比值为0.80时，敏感性为100.0% ，而特异性仅为58.1%。对于女性患者，比值为0.70时敏感性为57.3%，特异性为100.0%；比值为0.75时，敏感性为91.5%，特异性为95.9%；比值为0.80时，敏感性为100.0% ，而特异性仅为72.9%。固定截值点导致在年轻成人中许多气流阻塞患者被误诊、漏诊，比值为0.80时判定过多，比值为0.70时判定过少。总之，GINA防治指南中的气流阻塞定义需进行适当调整。
（ 陈欣 审校）
Eur Respir J. 2009 Sep;34(3):568-573.
What defines airflow obstruction in asthma?
Cerveri I, Corsico AG, Accordini S, Cervio G, Ansaldo E, Grosso A, Niniano R, Tsana Tegomo E, Antó JM, Künzli N, Janson C, Sunyer J, Svanes C, Heinrich J, Schouten JP, Wjst M, Pozzi E, de Marco R.
Asthma guidelines from the Global Initiative for Asthma (GINA) and from the National Heart, Lung, and Blood Institute provide conflicting definitions of airflow obstruction, suggesting a fixed forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) cut-off point and the lower limit of normality (LLN), respectively. The LLN was recommended by the recent American Thoracic Society/European Respiratory Society guidelines on lung function testing. The problem in using fixed cut-off points is that they are set regardless of age and sex in an attempt to simplify diagnosis at the expense of misclassification. The sensitivity and specificity of fixed FEV(1)/FVC ratios of 0.70, 0.75 and 0.80 versus the LLN were evaluated in 815 subjects (aged 20-44 yrs) with a diagnosis of asthma within the framework of the European Community Respiratory Health Survey. In males, the 0.70 ratio showed 76.5% sensitivity and 100.0% specificity, the 0.75 ratio 100.0% sensitivity and 92.4% specificity, and the 0.80 ratio 100.0% sensitivity but 58.1% specificity. In females, the 0.70 ratio showed 57.3% sensitivity and 100.0% specificity, the 0.75 ratio 91.5% sensitivity and 95.9% specificity, and the 0.80 ratio 100.0% sensitivity but 72.9% specificity. The fixed cut-off points cause a lot of misidentification of airflow obstruction in young adults, with overestimation with the 0.80 ratio and underestimation with the 0.70 ratio. In conclusion, the GINA guidelines should change their criteria for defining airflow obstruction.
Eur Respir J. 2009 Sep;34(3):568-73.
（ 陈欣 审校）
Eur Respir J. 2009 Sep;34(3):568-573.
What defines airflow obstruction in asthma?
Cerveri I, Corsico AG, Accordini S, Cervio G, Ansaldo E, Grosso A, Niniano R, Tsana Tegomo E, Antó JM, Künzli N, Janson C, Sunyer J, Svanes C, Heinrich J, Schouten JP, Wjst M, Pozzi E, de Marco R.
Asthma guidelines from the Global Initiative for Asthma (GINA) and from the National Heart, Lung, and Blood Institute provide conflicting definitions of airflow obstruction, suggesting a fixed forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) cut-off point and the lower limit of normality (LLN), respectively. The LLN was recommended by the recent American Thoracic Society/European Respiratory Society guidelines on lung function testing. The problem in using fixed cut-off points is that they are set regardless of age and sex in an attempt to simplify diagnosis at the expense of misclassification. The sensitivity and specificity of fixed FEV(1)/FVC ratios of 0.70, 0.75 and 0.80 versus the LLN were evaluated in 815 subjects (aged 20-44 yrs) with a diagnosis of asthma within the framework of the European Community Respiratory Health Survey. In males, the 0.70 ratio showed 76.5% sensitivity and 100.0% specificity, the 0.75 ratio 100.0% sensitivity and 92.4% specificity, and the 0.80 ratio 100.0% sensitivity but 58.1% specificity. In females, the 0.70 ratio showed 57.3% sensitivity and 100.0% specificity, the 0.75 ratio 91.5% sensitivity and 95.9% specificity, and the 0.80 ratio 100.0% sensitivity but 72.9% specificity. The fixed cut-off points cause a lot of misidentification of airflow obstruction in young adults, with overestimation with the 0.80 ratio and underestimation with the 0.70 ratio. In conclusion, the GINA guidelines should change their criteria for defining airflow obstruction.
Eur Respir J. 2009 Sep;34(3):568-73.
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咳嗽变异性哮喘和非哮喘慢性咳嗽同样存在气道壁增厚
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