肺功能联合睡眠呼吸暂停临床评分对慢性阻塞性肺疾病重叠阻塞性睡眠呼吸暂停患者的初筛价值

Value of pulmonary function combined with sleep apnea clinical score in preliminary screening for chronic obstructive pulmonary disease overlapping obstructive sleep apnea

摘要:

目的 探讨第1秒用力呼气容积占预计值百分比(FEV₁%pred)结合睡眠呼吸暂停临床评分(SACS)对慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)患者的初筛价值。方法 选取2020年1月至12月于航天中心医院呼吸与危重症医学科住院检查确诊为COPD的299例患者为研究对象,所有患者均完成肺功能FEV₁%pred检查以及SACS,行整夜多导睡眠图(PSG)监测。根据睡眠呼吸暂停低通气指数(AHI)将患者分为单纯COPD组和COPD合并OSA(重叠综合征,OVS)组。采用SPSS 23.0软件进行统计分析。根据数据类型,组间比较分别采用独立样本t检验或χ²检验。采用Pearson′s相关系数分析FEV₁%pred、SACS与AHI的相关性。采用受试者工作特征(ROC)曲线分析FEV₁%pred结合SACS预测COPD患者OVS的价值。 结果 OVS组FEV₁%pred [(53.4±15.1)和(43.6±13.9)%；P<0.05]及SACS[(19.1±3.9)和(7.3±2.1)分；P<0.05]显著高于单纯COPD组。相关性分析显示,AHI与FEV₁%pred(r=0.631,P<0.05)及SACS(r=0.689,P<0.05)呈正相关。ROC曲线显示,FEV₁%pred诊断OVS的最佳截断点为48.3%,灵敏度和特异度分别为81.3%和75.4%；SACS诊断OVS的最佳截断值为16,灵敏度和特异度分别为83.2%和79.3%；将FEV₁%pred≥48.3%和SACS≥16分作为联合指标诊断OVS的曲线下面积为0.812(95%CI 0.781～0.903),灵敏度和特异度分别为85.2%和79.5%。 结论 FEV₁%pred联合SACS评分对筛查COPD患者OVS具有良好的预测价值。

Abstract:

Objective To explore the value of percentage of forced expiratory volume in the predicted value in the first second (FEV₁%pred) combined with sleep apnea clinical score (SACS) in primary screening for patients with chronic obstructive pulmonary disease (COPD) complicated with obstructive sleep apnea (OSA). Methods A total of 299 patients diagnosed with COPD in our department from January to December 2020 were selected as the research objects. All patients completed FEV₁%pred examination of pulmonary function and SACS evaluation, and were monitored by overnight polysomnography (PSG). According to their sleep apnea hypopnea index (AHI), the patients were divided into simple COPD group and COPD combined with OSA (overlap syndrome, OVS). SPSS statistics 23.0 was used for statistical analysis. According to the data types, independent sample t-test or Chi-square test was adopted for intergroup comparison. Pearson′s correlation coefficient was used to analyze the correlation in FEV₁%pred, SACS and AHI. Receiver operating characteristic (ROC) curve was employed to analyze the value of FEV₁%pred combined with SACS in prediction of OVS in COPD patients. Results FEV₁%pred [(53.4±15.1) vs (43.6±13.9)%, P<0.05] and SACS [(19.1±3.9) vs (7.3±2.1) points, P<0.05] were significantly higher in the OVS group than the COPD group. Correlation analysis showed that AHI was positively correlated with FEV₁%pred (r=0.631, P<0.05) and SACS (r=0.689, P<0.05). ROC curve suggested that the best cut-off value of FEV₁%pred in the diagnosis of OVS was 48.3%, and the sensitivity and specificity were 81.3% and 75.4%, respectively. The best cut-off value of SACS for the diagnosis of OVS was 16, and the sensitivity and specificity were 83.2% and 79.3%, respectively. Taking FEV₁%pred ≥48.3% and SACS ≥16 points as joint indicators, the area under the curve for the diagnosis of OVS was 0.812 (95%CI 0.781-0.903), and the sensitivity and specificity were 85.2% and 79.5%, respectively. Conclusion FEV₁%pred combined with SACS has good predictive value in the screening of OVS in COPD patients.