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第46卷第5期
·674 · 南 京 医 科 大 学 学 报 2026年5月

second as a percentage of predicted value（FEV1% pred）<60% and forced vital capacity（FVC）≥ lower limit of normal］who
underwent pulmonary function tests at the First Affiliated Hospital of Nanjing Medical University from January 2022 to July 2024 were
enrolled. Patients were divided into inspiratory plateau group（n=53）and non⁃inspiratory plateau group matched for FEV 1%pred（n=56）
based on the presence or absence of inspiratory plateau. Demographic data，types of inhaled medications，acute exacerbation，chest CT
findings，pulmonary function parameters，and clinical comorbidities were collected and compared between the two groups. Multivariate
logistic regression identified factors associated with the F⁃V curve inspiratory plateau. A diagnostic model for identifying the inspiratory
plateau in patients with moderate ⁃ to ⁃ severe stable COPD was constructed and calibrated using the Hosmer ⁃ Lemeshow test，and
evaluated using the area under the receiver operating characteristic curve（AUC）. Chi⁃square test was used to preliminarily explore the
association between inspiratory plateau and various comorbidities in patients with moderate⁃to⁃severe stable COPD. Results：①The
difference in the proportion of pulmonary function stages between the two groups was not statistically significant（P > 0.05）. ② The
inspiratory plateau group exhibited significantly lower values for peak expiratory flow as a percentage of predicted value，peak
inspiratory flow（PIF），total lung capacity as a percentage of predicted value，and alveolar volume as a percentage of predicted value，
but significantly higher values for the ratios of peak expiratory flow（PEF）to PIF（PEF/PIF），the ratios of forced expiratory volume in
the first second（FEV1）to PEF（FEV1/PEF），resistance at 5 Hz（R5）as a percentage of predicted value，resistance at 20 Hz（R20）as a
percentage of predicted value，the difference between R 5 and R20 （R5-R20），and resistance of central airway（Rcentral）compared to the
non⁃inspiratory plateau group（P < 0.05）. ③No statistically significant difference was found in the rate of acute exacerbation between
groups（P > 0.05），although the inspiratory plateau group exhibited a higher acute exacerbation rate and slightly higher hospitalization
rate. ④A diagnostic model was constructed using PIF，PEF/PIF，FEV1/PEF and Rcentral. The optimal thresholds for the influencing
factors within this model were PIF≤3.91 L/s，PEF/PIF≥0.830，FEV1/PEF≥0.369 s and Rcentral≥1.905 cmH2O/（L·s）. This model
demonstrated strong discriminatory power with an AUC of 0.945. The Hosmer⁃Lemeshow goodness⁃of⁃fit test yielded a P⁃value of
0.957，indicating good model calibration. ⑤Compared with the non⁃inspiratory plateau group，the inspiratory plateau group had higher
prevalences of upper airway stenosis and central pulmonary malignancy，and the differences were statistically significant（P < 0.05）.
Conclusion：Moderate⁃to⁃severe stable COPD patients with inspiratory plateau in the F⁃V curve frequently exhibit increased overall
airway resistance，suggesting potential upper airway and surrounding disorders. Therefore，the presence of an inspiratory plateau should
be carefully evaluated in pulmonary function reports of moderate⁃to⁃severe stable COPD. A multi⁃parameter model incorporating PIF，
PEF/PIF，FEV1/PEF，and Rcentral may be utilized for identification，facilitating early detection of comorbidities in COPD patients.
［Key words］ chronic obstructive pulmonary disease；flow⁃volume curve；inspiratory plateau；pulmonary function testing；early
diagnosis
［J Nanjing Med Univ，2026，46（05）：673⁃684］

慢性阻塞性肺疾病（chronic obstructive pulmonary 塞部位涵盖胸内气道段（胸腔内气管和主支气管）或
［5-6］
disease，COPD）是一种以持续性呼吸道症状和不完 胸外气道段（咽部、喉部和胸腔外气管） 。我国肺
全可逆性气流受限为特征的异质性疾病，居全球死 功能指南中也指出吸气平台提示UAO，并依据阻塞
［1］
因第三位 。其核心病理改变集中于小气道及肺泡 部位对胸内压变化的动力学差异，将其分类为可变
结构，肺功能表现为小气道主导的阻塞性通气功能障 胸内型、可变胸外型和固定型 UAO 。目前，COPD
［7］
碍，特征包括：第1秒用力呼气容积（forced expiratory 患者合并吸气平台这一兼具病理生理与临床意义的
volume in the first second，FEV1）下降、FEV1与最大用力 重要征象，尚缺乏系统性研究，其临床价值未获得充
肺活量（forced vital capacity，FVC）的比值（FEV1/FVC） 分重视，导致常规诊疗中易被忽略。为此，本研究深
下降，流量⁃容积（flow⁃volume，F⁃V）曲线呼气下降支 入分析F⁃V曲线吸气平台对中重度稳定期COPD患
［2］
呈凹型 ，严重时伴有呼气下降支夹角的出现 ［3-4］ 。 者的病情评估和急性加重风险的预测价值，并进一
上述特征表明COPD的气流受限评估核心在于呼气 步探究出现此肺功能特征的潜在病理机制与病因。
相。然而，临床实践中发现部分 COPD 患者肺功能
1 对象和方法
检查中除典型的呼气相受限外，同时伴有吸气相平
台。现有研究明确提示吸气平台是中央或上气道阻 1.1 对象
塞（upper airway obstruction，UAO）的特征性征象，阻 筛选2022年1月—2024年7月在南京医科大学