Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis
Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis
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DOI：
10.1001/jamaoto.2018.2717
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发表时间：
2019-01-01
影响因子：
7.8
通讯作者：
Daniero, James J.
中科院分区：
文献类型：
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作者：
Carpenter, Delaney J.;Ferrante, Sergio;Daniero, James J.
重要性由于特发性声门下狭窄的复发性，常规随访对于监测狭窄的进展是必要的。然而，没有容易获得的，标准化的客观措施存在，以监测disease progress. ObjectiveTo确定是否呼气峰流量（PEF）可以作为一个可靠的和容易获得的生物学指标的疾病进展相对于其他有效的肺功能测定措施，在特发性声门下狭窄patients.Design，设置，和参与者收集数据的PEF，呼气不成比例指数（EDI），分析了2014年至2018年期间在一家三级转诊中心接受治疗的42名患有特发性声门下狭窄且未合并下气道或肺实质疾病的女性患者的总峰值流量（TPF）。平均随访时间为182个月（范围，2-40个月）。最初筛选的10例患者未纳入分析，由于共病声门或声门上狭窄或非特发性病因。主要结局和措施PEF，EDI和TPF的测量在术前访视和所有其他vision.Results四十二名妇女（平均年龄，51.5岁，98%白色[n = 41]）符合纳入标准。PEF的曲线下面积为0.855（95% CI，0.784-0.926）。最佳临界值为4.4升/秒（264 L/min），敏感性和特异性分别为84.4%和82.0%。EDI的曲线下面积为0.853（95% CI。0.782-0.925）。对于TPF，这是0.836（95%CI，0.757-0.916）。结论和相关性这项研究提供的证据支持使用PEF作为一种简单，有效，和可访问的方式监测进展的特发性声门下狭窄和预测接受手术干预。PEF的敏感性和特异性与更复杂的TPF和EDI指标相当。
IMPORTANCE Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression.OBJECTIVE To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis.DESIGN, SETTING, AND PARTICIPANTS Prospectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 182 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology.MAIN OUTCOMES AND MEASURES Measurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits.RESULTS Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI. 0.782-0.925). For TPF, this was 0.836 (95% CI, 0.757-0.916).CONCLUSIONS AND RELEVANCE This study provides evidence supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention. Sensitivity and specificity of PEF were comparable to those of the more complex measures of TPF arid EDI.