脉冲振荡技术参数联合模型在老年慢性阻塞性肺疾病中的诊断价值分析

Diagnostic value of a combined model of impulse oscillometry parameters in elderly patients with COPD

摘要

目的: 探讨脉冲振荡技术（impulse oscillometry system，IOS）在老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者中的诊断价值。方法: 采取单中心观察性研究，纳入2019年9月—2023年8月于南京医科大学第一附属医院就诊的670例老年COPD患者及101例健康对照者。所有受试者均先后完成IOS及肺量测定，收集其人口学特征、IOS参数及肺功能指标。IOS检测严格遵循国际与中国指南，记录5、10、20 Hz时的呼吸系统阻力（R5、R10、R20）和电抗（X5、X10、X20）、R5和R20之差（R5~R20）、共振频率（frequency of resonance，Fres）等指标，并进行Z分数标准化。采用Spearman相关性、广义线性模型（Gamma分布，Log连接）及分位数回归（τ=0.5）评估IOS参数与肺功能指标的关系，通过ROC曲线评估诊断效能。结果: 与对照组相比，COPD组R5、R5~R20、Fres增高，X5降低（P均<0.001）。相关性分析显示，R5、R5-R20、Fres与第1秒用力呼气容积占预计值百分比（FEV1%pred）呈负相关（R5： r=-0.500， P<0.001；R5~R20： r=-0.584， P<0.001；Fres： r=-0.546， P<0.001），X5、X20与FEV1%pred呈正相关（X5： r=0.609， P<0.001；X20： r=0.529， P<0.001），校正年龄、性别、BMI及吸烟指数后，GOLD 2、3、4级患者的R5-R20较GOLD 1级分别增加34.3%、119.2%、189.2%（P均<0.001）；R5分别增加15.2%、49.3%和66.6%（P均<0.001）；Fres分别增加16.0%、42.1%和64.6%（P均<0.001）；X5和X20逐级降低，X5系数为-0.047、-0.186和-0.328（P均<0.001）；X20系数依次为-0.025、-0.059和-0.089（P均<0.001）。联合Fres、R5、R20、X5、X20的多参数模型诊断效能提升，AUC达0.803（95%CI：0.761~0.845），灵敏度为59%，特异度为88%，Nagelkerke R²为38%。结论: 脉冲振荡技术可有效评估老年COPD患者的气道阻力和肺弹性特性，多参数联合诊断模型具有一定诊断效能，可作为老年COPD的重要辅助诊断工具。

Abstract

Objective: To investigate the diagnostic value of impulse oscillometry (IOS) in older patients with chronic obstructive pulmonary disease (COPD). Methods: This single-center observational study enrolled 670 older patients with COPD and 101 healthy controls who attended the First Affiliated Hospital of Nanjing Medical University between September 2019 and August 2023. All participants underwent IOS followed by spirometry. Demographic characteristics, IOS parameters, and spirometric indices were collected. IOS measurements were performed in strict accordance with international and Chinese guidelines. Respiratory system resistance at 5, 10, and 20 Hz (R5, R10, and R20), respiratory system reactance at 5, 10, and 20 Hz (X5, X10, and X20), the difference between R5 and R20 (R5-R20), and resonant frequency (Fres) were recorded and converted to Z scores. Spearman correlation analysis, generalized linear models with a gamma distribution and log-link function, and median quantile regression ( τ=0.5) were used to evaluate the associations between IOS parameters and spirometric indices. Receiver operating characteristic (ROC) curve analysis was performed to assess diagnostic performance. Results: Compared with healthy controls, patients with COPD had significantly higher R5, R5-R20, and Fres and significantly lower X5 values (all P<0.001). R5, R5-R20, and Fres were negatively correlated with the percentage of predicted forced expiratory volume in 1 second (FEV1% predicted; R5: r=-0.500, P<0.001; R5-R20: r=-0.584, P<0.001; Fres: r=-0.546, P<0.001). In contrast, X5 and X20 were positively correlated with FEV1% predicted (X5: r=0.609, P<0.001; X20: r=0.529, P<0.001). After adjustment for age, sex, body mass index, and smoking index, R5-R20 was 34.3%, 119.2%, and 189.2% higher in patients with global initiative for chronic obstructive lung disease (GOLD) grades 2, 3, and 4, respectively, than in those with GOLD grade 1 (all P<0.001). The corresponding increases in R5 were 15.2%, 49.3%, and 66.6% (all P<0.001), whereas Fres increased by 16.0%, 42.1%, and 64.6%, respectively (all P<0.001). X5 and X20 progressively decreased with increasing GOLD grade. The regression coefficients for X5 were -0.047, -0.186, and -0.328 for GOLD grades 2, 3, and 4, respectively, and those for X20 were -0.025, -0.059, and -0.089, respectively (all P<0.001). A multivariable model combining Fres, R5, R20, X5, and X20 demonstrated improved diagnostic performance, with an area under the ROC curve of 0.803 (95% confidence interval: 0.761-0.845), a sensitivity of 59%, a specificity of 88%, and a Nagelkerke R ² of 38%. Conclusion: IOS can effectively characterize airway resistance and the elastic properties of the respiratory system in older patients with COPD. A diagnostic model combining multiple IOS parameters showed moderate diagnostic performance and may serve as a useful adjunctive tool for the diagnosis of COPD in older adults.

关键词

慢性阻塞性肺疾病 / 脉冲振荡技术 / 肺量测定法 / 小气道功能障碍 / 诊断效能

Key words

chronic obstructive pulmonary disease / impulse oscillometry / spirometry / small airway dysfunction / diagnostic performance

参考文献

[1] VOLLSET S E, ABABNEH H S, ABATE Y H, et al. GBD 2021 Forecasting Collaborators. Burden of disease scenarios for 204 countries and territories, 2022—2050: a forecasting analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440):2204-2256

[2] 基本公共卫生服务项目基层慢阻肺病防治管理办公室, 国家慢性呼吸疾病防治办公室, 国家呼吸医学中心, 等. 国家基层慢性阻塞性肺疾病防治及管理实施指南（2025）[J]. 中华结核和呼吸杂志, 2026, 49(01): 11-28

[3] Basic Public Health Service Project Primary COPD Prevention and Management Office, National Chronic Respiratory Disease Prevention and Control Office, National Respiratory Medicine Center, et al. National primary chronic obstructive pulmonary disease prevention and management implementation guide (2025)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2026, 49(01): 11-28

[4] 中国老年医学学会呼吸病学分会慢性阻塞性肺疾病学组. 中国老年慢性阻塞性肺疾病临床诊治实践指南[J]. 中华结核和呼吸杂志, 2020, 43(02): 100-119

[5] Chronic Obstructive Pulmonary Disease Group, Respiratory Branch of Chinese Geriatrics Society. Clinical practice guideline for diagnosis and management of chronic obstructive pulmonary disease in elderly patients[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020, 43(02): 100-119

[6] CENGIZ S K, SAVAS I K, COSKUN E, et al. Conformity of spirometric tests with acceptability criteria and assessment of confounding factors in routine clinical practice[J]. Ann Thorac Med, 2025, 20(3):176-182

[7] 中华医学会呼吸病学分会肺功能学组. 成人肺功能检查技术进展及临床应用推荐指南（2025版）[J]. 中华肺部疾病杂志（电子版）, 2025, 18(2): 197-212

[8] Pulmonary Function Group, Respiratory Branch of Chinese Medical Association. Recommended guidelines for technical advances and clinical application of adult pulmonary function testing (2025 edition)[J]. Chinese Journal of Pulmonary Diseases (Electronic Edition), 2025, 18(2): 197-212

[9] KING G G, BATES J, BERGER K I, et al. Technical standards for respiratory oscillometry[J]. Eur Respir J, 2020, 55(2):1900753

[10] RINGBAEK T, FRØLUND L, MORTENSEN J, et al. Comparing changes in FEV(1) and impulse oscillometry parameters following methacholine challenge testing: physiological correlates, clinical markers, and pulmonary symptoms[J]. J Clin Med, 2026, 15(5):2025

[11] 中国医师协会呼吸医师分会肺功能与临床呼吸生理工作委员会, 中华医学会呼吸病学分会肺功能学组, 中国老年医学会呼吸分会肺功能学组. 肺功能检查技术规范——脉冲振荡技术检查[J]. 中华结核和呼吸杂志, 2022, 45(10): 960-969

[12] Committee on Pulmonary Function and Clinical Respiratory Physiology, Respiratory Physician Branch of Chinese Medical Doctor Association; Pulmonary Function Group, Respiratory Branch of Chinese Medical Association; Pulmonary Function Group, Respiratory Branch of Chinese Geriatric Society. Technical standards for pulmonary function tests: impulse oscillometry[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 45(10):960-969

[13] LIANG X, ZHENG J, GAO Y, et al. Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry[J]. ERJ Open Res, 2022, 8(4):00080—2022

[14] JIAN W, GAO Y, HAO C, et al. Reference values for spirometry in Chinese aged 4—80 years[J]. J Thorac Dis, 2017, 9(11):4538-4549

[15] HUANG S, WU F, DENG Z, et al. Comparing spirometry, impulse oscillometry with computed tomography for assessing small airway dysfunction in subjects with and without chronic obstructive pulmonary disease[J]. BMC Pulm Med, 2025, 25(1):45

[16] COSÍO B G, CASANOVA C, SOLER—CATALUÑA J J, et al. Unravelling young COPD and pre—COPD in the general population[J]. ERJ Open Res, 2023, 9(1):00334—2022

[17] LI Y, SU K C, HSIAO Y H, et al. The impact of age and disease entity on small airway dysfunction in obstructive airway diseases[J]. Int J Chron Obstruct Pulmon Dis, 2025, 20:821-830

[18] Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report[EB/OL]. (2025—11—11)[ 2026—06—03]. https://goldcopd.org/2026—gold—report/, 2026

[19] PENG J, LI X, ZHOU H, et al. Clinical value of impulse oscillometry in chronic obstructive pulmonary disease: a systematic review and meta—analysis[J]. Respiration, 2025, 104(2):100-109

[20] TAMURA K, SHIRAI T, HIRAI K, et al. Mucus plugs and small airway dysfunction in asthma, COPD, and asthma—COPD overlap[J]. Allergy Asthma Immunol Res, 2022, 14(2):196-209

[21] KLITGAARD A, LØKKE A, HILBERG O. Impulse oscillometry as a diagnostic test for pulmonary emphysema in a clinical setting[J]. J Clin Med, 2023, 12(4):1547

[22] XU J, SUN X, ZHU H, et al. Long—term variability of impulse oscillometry and spirometry in stable COPD and asthma[J]. Respir Res, 2022, 23(1):262

[23] LU L, TANG G, WAN Q, et al. Long—term variability of impulse oscillometry defined small airway dysfunction in participants with and without chronic obstructive pulmonary disease[J]. BMJ Open Respir Res, 2026, 13(1):e003918

[24] FÄRDIG M, LINGMAN K, LISSPERS K, et al. Peripheral airway function and disease burden in COPD[J]. ERJ Open Res, 2025, 11(4):01078—2024

[25] HUANG Y, ZHANG X, WANG J, et al. Role of impulse oscillometry in chronic obstructive pulmonary disease and asthma—chronic obstructive pulmonary disease overlap[J]. Clin Transl Allergy, 2025, 15(4):e70057

基金资助

国家科技重大专项(2023ZD0506300)

国家自然科学基金(82300033)