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. 2020 Feb 2;58(2):140-144.
doi: 10.3760/cma.j.issn.0578-1310.2020.02.014.

[The cutoff value of FEV(1)/FVC as the criteria of airway obstruction in children]

[Article in Chinese]
Affiliations

[The cutoff value of FEV(1)/FVC as the criteria of airway obstruction in children]

[Article in Chinese]
J X Zhang et al. Zhonghua Er Ke Za Zhi. .

Abstract

Objective: To explore the cutoff value of FEV(1)/FVC for evaluating obstructive ventilation dysfunction in children. Methods: Three hundred and eighty-three healthy children (190 boys and 193 girls) aged 6-14 years in primary and middle school in Beijing, who were enrolled from May 2010 to June 2011, had their spirometry done with the Jaeger lung function instrument, and the lower limit of normal (LLN) of FEV(1)/FVC was calculated. Two hundred and thirteen asthmatic children (151 boys and 62 girls) aged 6-14 years from the outpatient Department of Allergy, Capital Institute of Pediatrics were enrolled consecutively from June to July 2018, whose clinical history and pulmonary function parameters were collected. The expected value of spirometric parameters of asthmatic children was calculated according to Zapletal prediction equations. And the LLN of FEV(1)/FVC in healthy children was used as the gold standard to calculate the sensitivity, specificity, Youden index and Kappa value of FEV(1)/FVC<80% and FEV(1)/FVC< 92% predicted. Results: In healthy children, the FEV(1)/FVC and the LLN were 91%±5% and 82% respectively, while 90%±6% and 81% in boys, and 92%±5% and 84% in girls. There were 27 (12.7%) asthmatic children whose FEV(1)/FVC<80% but FEV(1)/FVC≥92% predicted (χ(2)=123.7, P<0.01). The sensitivity, specificity, Youden index and Kappa value of FEV(1)/FVC<80% were 80.3%, 100%, 0.803 and 0.787 respectively when FEV(1)/FVC<80% was used as the criteria to assess lung function, while they were 57.3%, 100%, 0.573 and 0.547, respectively, when FEV(1)/FVC<92% predicted was used as criteria. Conclusions: The 80% of FEV(1)/FVC has a better consistency with the LLN of FEV(1)/FVC than 92% of FEV(1)/FVC% predicted. It is more accarate to use FEV(1)/FVC<80% as the diagnostic criteria for airway obstruction.

目的: 探讨使用肺功能1秒率判断患儿存在阻塞性通气功能障碍时界值的选取。 方法: 采取临床诊断性试验研究,选取2010年5月至2011年6月北京市中小学6~14岁健康儿童383名(男190名,女193名),使用德国Jaeger肺功能仪进行流量-容积曲线测定,计算1秒率的正常值低限(LLN)。2018年6至7月,连续纳入在首都儿科研究所附属儿童医院哮喘门诊就诊的6~14岁的哮喘患儿213例(男151例,女62例),收集患儿的临床资料及主要肺通气功能参数,使用Zapletal预计值公式作为所调查患儿的预计值,计算各参数实测值占预计值的百分比。以健康儿童1秒率的LLN作为金标准,计算1秒率实测值80%及实测值占预计值92%这两种不同的判断标准的灵敏度、特异度、Youden指数及Kappa值。 结果: 383名健康儿童1秒率实测值为91%±5%,LLN为82%,其中男童1秒率实测值为90%±6%,LLN为81%;女童1秒率实测值为92%±5%,LLN为84%。213例哮喘患儿中,1秒率实测值<80%但1秒率占预计值的百分比≥92%的有27例(12.7%),两种标准判断的不一致率达12.7%,差异有统计学意义(χ(2)=123.7,P<0.01)。以1秒率实测值<80%作为判断标准时,其灵敏度为80.3%,特异度为100.0%,Youden指数为0.803,Kappa值为0.787;而以1秒率实测值占预计值百分比<92%作为判断标准时,其灵敏度为57.3%,特异度为100%,Youden指数为0.573,Kappa值为0.547。 结论: 在使用Zapletal预计值公式的情况下,1秒率实测值为80%时与1秒率实测值LLN的一致性更好,采用1秒率实测值80%作为判断气道阻塞的标准更为准确。.

Keywords: Airway Obstruction; Asthma; Children; Spirometry.

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