诊疗方案
ENGLISH ABSTRACT
更新版国内外肺量计检查指南的异同及重点解读
王译民
陈文雅
简文华
高怡
郑劲平
作者及单位信息
·
DOI: 10.3760/cma.j.cn112147-20210412-00244
Standardization of spirometry updated in China and international: comparison and interpretation of the key updates
Wang Yimin
Chen Wenya
Jian Wenhua
Gao Yi
Zheng Jinping
Authors Info & Affiliations
Wang Yimin
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Chen Wenya
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Jian Wenhua
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Gao Yi
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
Zheng Jinping
National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
·
DOI: 10.3760/cma.j.cn112147-20210412-00244
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摘要

美国胸科学会(ATS)和欧洲呼吸协会在2019年更新了肺量计检查标准化指南。我国目前应用的指南为中华医学会呼吸病学分会(CTS)发布的肺量计检查指南,以及CTS和中国医师协会呼吸医师分会联合发布的肺功能检查报告规范。本文对比并重点解读了不同版本国内外指南主要内容的异同点。国外指南新增检查适应证,禁忌证设置基于患者病理生理角度,有别于国内指南按禁忌证强度划分;肺量计仪性能测试标准在国内外指南分别采用ATS 标准和ISO 26782∶2009标准测试;国外指南增加了对3 L定标筒的质控规定,并对操作者提出了培训、达标及能力维持要求,质量等级增加了U级,还新增了质控不合格警告,患者指导和标准化操作者评论等标准,这些在国内指南的建议中有些未详细解释。国内指南强调的用力吸气相指标及小气道指标在国外指南中无明确要求。相比而言,国外较国内指南在采用指标的要求更严,原因解释更详细,优秀部分值得我国指南的更新版借鉴,但结合我国国情的肺量计指标需予保留和推广。

ABSTRACT

Standardization of spirometry was jointly updated by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in 2019. Similar technical standards for spirometry recommended by the Chinese Thoracic Society (CTS) and/or the Chinese Association of Chest Physicians (CACP) are widely used in China. We compared the key similarities and differences of these recommendations and interpreted the key updates. The ATS/ERS 2019 updates expanded the scope of indications for spirometry and recommended the contraindications based on the pathophysiological perspective, while contraindications recommended by the CTS were based on the severity of contraindications. ISO 26782∶2009 standards were applied by the ATS/ERS 2019 to evaluate the performance quality (reliance for accuracy, repeatability, etc.) of spirometers, while standards adopted 24/26 waves suggested by the ATS 1994 was used by the CTS. The ATS/ERS 2019 also included the performance quality control criteria for 3-L calibration syringe, operator training and attainment and maintenance of competency, grade“U”, system warning messages, instructions to patients, and standardized operator comments. Some of these criteria in the CTS were not explained in detail. However, the CTS/CACP emphasized that the spirometry record should report the indices of forced inspiratory phase and small airway function, those are not clearly required in the ATS/ERS 2019. In comparison, the ATS/ERS 2019 has stricter criteria for FEV 1 and FVC acceptability than the CTS and more detailed explanations. Those outstanding parts are worth referencing for the updated version of the CTS in the future, while the criteria that combine our own conditions need to be retained and popularized.

Zheng Jinping, Email: mocdef.3ab61yggnehzpj
引用本文

王译民,陈文雅,简文华,等. 更新版国内外肺量计检查指南的异同及重点解读[J]. 中华结核和呼吸杂志,2022,45(03):250-254.

DOI:10.3760/cma.j.cn112147-20210412-00244

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肺功能检查在呼吸系统疾病早期筛查、诊断、评估、监测和管理中发挥重要作用 1 , 2 , 3。然而,我国约1亿慢性阻塞性肺疾病(简称慢阻肺)患者中仅12%曾经完成过肺功能检查 4。国务院颁布了《关于实施健康中国行动的意见》(国发〔2019〕13号),其中在实施慢性呼吸系统疾病防治行动中明确要求“高危人群首诊测量肺功能、40岁及以上人群体检检测肺功能,提高基层医疗卫生机构肺功能检查能力”,提示肺功能在慢性呼吸疾病防治中的重要地位。中央抗疫国债支持的公共卫生体系建设和重大疫情防控救治体系建设项目(国卫财务函〔2020〕303号)中设立了基层呼吸系统疾病早期筛查干预能力提升项目。其中要求“50%的基层医疗卫生机构配备肺功能仪;已配备肺功能仪的机构,肺功能仪使用率要达到90%”。这些政策的实施推动了肺功能检查在我国基层医疗卫生机构中的应用 5。然而,良好的肺功能检查需要严格执行质量控制(简称质控)。依据不符合质控要求的肺量计检查来诊断慢阻肺是不可靠的,将导致50%的病例误诊 6
肺量计检查是肺功能最重要和常用的检查方法。早在1979年美国胸科学会(ATS)雪鸟工作组就发布了第一版肺量计检查标准化指南 7。此后分别在1987和1994年进行了更新 8 , 9。同时欧洲呼吸协会(ERS)也发布了肺功能检查标准化指南 10。2005年ATS和ERS首次共同发布了肺量计检查标准化指南(简称ATS/ERS 2005),这是迄今为止应用最广、引用率最高的一版指南 11。2017年ATS推荐了标准化肺功能检查报告(简称ATS 2017) 12,2019年ATS/ERS在2005年基础上进行了肺量计检查标准指南更新(简称ATS/ERS 2019) 13。在我国,中华医学会呼吸病学分会(CTS)在2014年发布了肺量计检查指南(简称CTS 2014) 14,中华医学会儿科学分会在2016年发布了儿童肺容积和通气功能指南 15,2019年CTS和中国医师协会呼吸医师分会(CACP)联合发布了肺功能检查报告规范(简称CTS/CACP 2019) 16。为更好地结合我国实际情况来应用各版本指南,本文对比了不同版本国内外指南的异同,对临床常见问题、技术指标和质控指标等重点内容进行解读,并探讨今后我国指南更新时可沿用或借鉴国外指南进行更新和补充的建议;对ATS/ERS 2019未更新的内容,如检查定义、指标及结果判断等仅做简要论述,不做重点探讨。
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备注信息
A
郑劲平,Email: mocdef.3ab61yggnehzpj
B

王译民, 陈文雅, 简文华, 等. 更新版国内外肺量计检查指南的异同及重点解读[J]. 中华结核和呼吸杂志, 2022, 45(3): 250-254. DOI: 10.3760/cma.j.cn112147-20210412-00244.

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国家重点研发计划 (2018YFC1311900,2016YFC1304603)
国家科技支撑计划 (2015BAI12B10)
广州市科技计划 (202007040003)
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