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Title: [Value of forced expiratory volume in 6 seconds (FEV(6)) in the evaluation of pulmonary function in Chinese elderly males].
Author: Pan MM, Zhang HS, Sun TY.
Journal: Zhonghua Yi Xue Za Zhi; 2017 May 30; 97(20):1556-1561. PubMed ID: 28592061.
Abstract:
Objective: To evaluate the value of forced expiratory volume in 6 seconds (FEV(6)) in the evaluation of pulmonary function in Chinese elderly males. Methods: Pulmonary function tests of elderly who had received regular physical examination in Beijing Hospital from July 2003 to April 2015 were analyzed on subjects with the following characteristics: aged 60 years or older, completion of bronchial dilation test and able to exhale for at least six seconds. The included subjects were divided into 2 groups: 60-<80 years group and ≥80 years group. The association of FEV(6) with forced vital capacity (FVC), FEV(1)/FEV(6) with FEV(1)/FVC, the diagnostic efficiency and influencing factor of FEV(6) and FEV(1)/FEV(6) were analyzed; the value of FEV(6) in the evaluation of pulmonary function in the study population was evaluated. Results: A total of 475 elderly men aged 60 years or older were enrolled, with a mean age of (77.13±9.53) years. Totally there were 269 subjects in 60-<80 years group, which accounted for 56.6%; 206 subjects were in ≥80 years group, which accounted for 43.4%. There were 292 subjects with irreversible airflow obstruction, accounting for 61.5%. In all the included subjects, FEV(6) was significantly correlated with FVC and post-bronchodilator FEV(1)/FEV(6) was significantly correlated with post-bronchodilator FEV(1)/FVC(r=0.971, 0.978; both P<0.001), which were similar in 60-<80 years group and ≥80 years group (r=0.967, 0.974 and r=0.955, 0.967; all P<0.001). FEV(1)/FEV(6) showed excellent accuracy in diagnosing airflow obstruction[area under curve (AUC)=0.990(95%CI: 0.983-0.996); P<0.001]. Using FEV(1)/FVC<0.70 as a reference, FEV(1)/FEV(6)<0.73 had the best sensitivity (0.952) and specificity (0.945), and there was excellent agreement between the two diagnostic cutoffs (κ=0.891; P<0.001). When difference between before and after bronchial dilation test was analyzed, no correlation was observed between FEV(6) improvement and the improvement of forced expiratory time (r=0.089; P=0.053), but FVC improvement was significantly correlated with the improvement of forced expiratory time (r=0.460; P<0.001). Similar results were also found in subjects with irreversible airflow obstruction. Subjects with FEV(1)/FEV(6)≥0.70 and FEV(1)/FVC<0.70 were categorized as pulmonary function middle group, a total of 73 cases, which included 20 cases ≥80 years old. The proportion of middle group among ≥80 years group was significantly less than that of the 60-<80 years group (χ(2)=8.958; P=0.003). In pulmonary function middle group, FEV(1)/FEV(6) or FEV(1)/FVC had no correlation with inspiratory capacity or residual volume/total lung capacity (all P>0.05). Conclusions: FEV(6) and FEV(1)/FEV(6) are strongly correlated with FVC and FEV(1)/FVC, and there is excellent agreement between FEV(1)/FEV(6) and FEV(1)/FVC. FEV(6) is simple, easy to operate and with less influencing factors, which can be used as a valid alternative for FVC in diagnosing airflow obstruction in elderly males. 目的： 评价六秒用力呼气量(FEV(6))在老年男性肺功能评价中的应用价值。 方法： 以年龄≥60岁为标准，筛选2003年7月至2015年4月于北京医院进行体检的老年男性人群的肺功能检查资料，以完成支气管舒张试验、FEV(6)等指标齐备为入选标准，将入选的老年受试者分为2组：60～<80岁组及≥80岁组，分析FEV(6)与用力肺活量(FVC)、支气管舒张试验后的一秒用力呼气量(FEV(1))/FEV(6)与FEV(1)/FVC的相关性、诊断效能及影响因素，评价FEV(6)在老年肺功能评价中的应用价值。 结果： 共入选475名年龄≥60岁的老年男性，平均年龄(77.13±9.53)岁。其中60～<80岁组269名(56.6%)，≥80岁组206名(43.4%)；292名(61.5%)存在不可逆性气流受限。全部入选者FEV(6)与FVC、FEV(1)/FEV(6)与FEV(1)/FVC均显著相关(r＝0.971、0.978，均P<0.001)；60～<80岁组和≥80岁组上述指标间也均显著相关(r＝0.967、0.974和r＝0.955、0.967；均P<0.001)。FEV(1)/FEV(6)在诊断气流受限方面有很好的诊断灵敏度[ROC曲线下面积为0.990(95%CI：0.983～0.996)，P<0.001]；与FEV(1)/FVC<0.70相比，FEV(1)/FEV(6)临界值取0.73可获得最佳敏感度(0.952)及特异度(0.945)，具有良好的诊断一致性(κ＝0.891，P<0.001)。支气管舒张试验前后，全部入选者FEV(6)改善值与用力呼气时间无显著相关性(r＝0.089，P＝0.053)，而FVC改善值与呼气时间显著相关(r＝0.460，P<0.001)。在不可逆性气流受限的受试者中也有相似结果。将FEV(1)/FEV(6)≥0.70同时FEV(1)/FVC<0.70的受试者作为中间肺功能组，共73名，其中20名≥80岁。中间肺功能组在≥80岁组中所占比例明显<60～<80岁组(χ(2)＝8.958，P＝0.003)。中间肺功能组受试者中，FEV(1)/FEV(6)、FEV(1)/FVC值与深吸气量、残气量/肺总量的检测结果均无显著相关性(均P>0.05)，与无气流受限人群相似。 结论： FEV(6)与FVC、FEV(1)/FEV(6)与FEV(1)/FVC密切相关，对老年人持续性气流受限诊断一致性良好，呼气影响因素少，简便易行；FEV(6)在老年男性肺功能评价中可用于替代FVC。.

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