Primary construction of pre⁃hospital screening model for chronic obstructive pulmonary disease
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摘要:
目的:通过观察研究慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者特异性相关因素,构建COPD院前筛查模型,以提高COPD高危人群肺功能检查实施率,从而降低COPD的漏诊率及病死率。方法:入组稳定期COPD患者68例,对照组40例,收集基本资料,同时进行COPD评估测试(COPD assessment test,CAT)、运动中脉率和指脉氧检测及肺功能测试。采用Logistic回归分析法确定与COPD相关的自变量,构建COPD筛查模型,用Hosmer-Lemeshow检验进行校正,用受试者工作特征曲线下面积(area under receiver operating characteristic curve,AUROC)进行判别。结果:与对照组相比,稳定期COPD患者的年龄、吸烟指数、体重指数(body mass index,BMI)、CAT评分、最低指脉氧(SPO2L)、最高脉率差异有统计学意义。吸烟指数、CAT评分、SPO2L构成筛查模型,用来估计COPD的概率(probability of COPD,PCOPD),PCOPD的最佳阈值为57.1%。筛查模型中影响因素的最佳阈值为吸烟指数≥220支·年、CAT评分≥7.5分、SPO2L≤93.5%。该模型的AUROC为0.938,模型判别能力强,Hosmer-Lemeshow拟合度检验P=0.789,模型校正良好。结论:吸烟指数,CAT评分,SpO2L构成了COPD院前筛查模型,该模型具有良好的区分性和校正,且PCOPD≥57.1%可能为COPD高危患者,建议其进行肺功能检测以明确诊断,从而降低COPD的漏诊率。吸烟指数≥220支·年、CAT评分≥7.5分、SPO2L≤93.5%时,对COPD筛查具有指导意义。
Abstract:
Objective:By observing and studying the specific related factors of patients with chronic obstructive pulmonary disease(COPD),a pre-hospital screening model of COPD was established to improve the implementation rate of pulmonary function examination in high-risk groups of COPD,so as to reduce the rate of missed diagnosis and mortality of COPD. Methods:Total 68 patients with stable COPD and 40 patients in the control group were enrolled. Their basic data were collected,and COPD assessment test(CAT),pulse rate and finger pulse oxygen measurement during exercise and pulmonary function test were performed at the same time. Logistic regression analysis was used to determine the independent variables related to COPD,and COPD screening model was constructed,which was corrected by Hosmer-Lemeshow test and discriminated by area under receiver operating characteristic curve(AUROC). Results:There were significant differences in age,smoking index,body mass index(BMI),CAT score,lowest finger pulse oxygen(SPO2L)and highest pulse rate between the control group and stable COPD patients. Smoking index,CAT score and SPO2L constituted the screening model,and used to estimate the probability of COPD(PCOPD).The best threshold of PCOPD was 57.1%. The best thresholds of influencing factors in the screening model were smoking index ≥220 cigarette-years,CAT score ≥ 7.5 and SPO2L ≤ 93.5%. The AUROC of the model was 0.938 with strong discriminant ability . The model correction was good with the Hosmer-Lemeshow fitting test P=0.789. Conclusion:Smoking index,CAT score and SPO2L constitute the pre-hospital screening model for COPD,which has good differentiation and correction. When PCOPD ≥ 57.1%,it is helpful for doctors to effectively screen high-risk patients with COPD,and it is recommended to carry out lung function test to confirm the diagnosis, so as to reduce the rate of missed diagnosis of COPD. When smoking index ≥ 220 cigarette-years,CAT score ≥ 7.5 and SPO2L ≤ 93.5%,it has good guiding significance for COPD screening.