Is an FEV1 of 80% predicted a normal spirometry in cystic fibrosis children and adults?
Is an FEV1 of 80% predicted a normal spirometry in cystic fibrosis children and adults?
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DOI：
10.1111/crj.12920
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发表时间：
2018-08-01
影响因子：
1.7
通讯作者：
Hewett, John
中科院分区：
文献类型：
--
作者：
Konig, Peter;Ner, Zarah;Hewett, John
fev(1)被认为是评估和治疗囊性纤维化肺病的金标准肺活量测定方法。最近的证据表明，在肺容量较小的情况下进行检测可能更敏感。目的评估在FEV1正常的情况下，有多少其他肺活量测定法是异常的（80%），以及哪些肺活量测定法对检测气道阻塞最敏感。方法回顾性分析184例6 ~ 57岁囊性纤维化患者3169例肺活量测定结果。如果测试符合ATS标准，则可接受。结果FEV1、FEF75正常组梗阻率为58%，FEF25-75为31%，FEV1/FVC比值为72%。总的来说，75%的测试有异常。FEF75、FEF25-75、FEF50和FEV1/FVC比值对梗阻的识别敏感性均显著高于FEV1。FEV1/FVC比值在所有诊断梗阻的试验中是最敏感的，但在成人（0 ~ 20岁）中，FEF75（90%）比FEV1/FVC比值（85%）更敏感。FEF25-75的灵敏度也达到85%。尽管FEV1/FVC比率是所有测试中最敏感的，但在存在正常比率的情况下，35%的其他测试是异常的。结论FEV1正常不代表肺活量正常。FEV1/FVC是囊性纤维化患儿早期或轻度气道阻塞的最敏感指标。如果只考虑FEV1/FVC比值，会遗漏很多梗阻病例，因此在临床评价气道梗阻时应综合考虑所有的肺活量测定方法。
IntroductionFEV(1) is considered the gold standard spirometric measure for the assessment and management of cystic fibrosis lung disease. Recent evidence suggests that tests at lower lung volumes may be more sensitive.ObjectivesTo assess how many other spirometric tests are abnormal in the presence of a normal FEV1 (80%) and which spirometric tests are most sensitive in detecting airway obstruction.MethodsThis was a retrospective analysis of 3169 spirometry tests on 184 patients with cystic fibrosis aged 6-57 years. Tests were acceptable if they met ATS criteria.ResultsTests with normal FEV1, FEF75 showed obstruction in 58% of tests, FEF25-75 in 31% and FEV1/FVC ratio in 72%. Overall 75% of tests had an abnormality. FEF75, FEF25-75, FEF50 and FEV1/FVC ratio were all significantly more sensitive in identifying obstruction than FEV1. The FEV1/FVC ratio was the most sensitive of all tests in identifying obstruction except in adults (> 20 years), in whom FEF75 at 90%, was more sensitive than the ratio at 85%. FEF25-75 was also at 85% sensitive. Even though the FEV1/FVC ratio was the most sensitive of all tests, in the presence of a normal ratio, 35% other tests were abnormal.ConclusionsNormal FEV1, is not indicative of normal spirometry. FEV1/FVC is the most sensitive measure of early or mild airway obstruction in children with cystic fibrosis. If only the FEV1/FVC ratio was considered, many cases of obstruction would be missed, therefore all spirometric measures should be considered in the clinical evaluation of airway obstruction.