中国循证医学杂志

中国循证医学杂志

“美国胸科学会推荐的标准化肺功能报告”之解读和商榷

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美国胸科学会(ATS)肺功能专业委员会针对肺功能报告缺乏统一格式可能带来的临床诊治困惑,推荐使用标准化肺功能报告格式,以提高临床对肺功能检查结果的正确解读和信息传递。ATS 推荐的标准化肺功能报告分为概述、引言、方法、报告格式、正常预计值选用、质量控制分级及结论等 7 部分。重点提出了标准化报告格式的原则,主要肺功能检查(如肺量计检查、弥散功能检查、肺容量检查等)的报告格式、指标、表述方式、数据排列和展现顺序,正常预计值的选取及解读,肺功能质控图形规范,以及肺功能检查质量控制分级评估等内容。其中,特别详细介绍了对预计值的解读,建议采用正常预计值下限(LLN)或标准差倍数(z 值)取代目前常用的占正常预计值百分率作为异常阈值的判读。该规范报告对各项建议提供了解释详尽的理由、清晰直观,对促进肺功能检查的规范化意义重大。但在应用中需结合我国实际国情。本文提出了部分商榷建议:强调需选用适合中国人的肺量计正常预计值,建议增加呼气中期流速等小气道功能指标,重视吸气相流量容积曲线及其指标的报告,强化报告肺功能质控数据及图形次数等。

The American Thoracic Society Committee Task Force on Standards for Pulmonary Function had recommended a standardized reporting format for pulmonary function tests due to considerable variability in pulmonary function reports presented to end users, which might lead to potential confusion and miscommunication. This recommendation includes seven parts: overview, introduction, methods, report format, selecting and reporting reference values, grading the quality of pulmonary function tests and conclusions. This document presents a reporting format in test-specific units for spirometry, lung volumes, and diffusing capacity that can be assembled into a report appropriate for a laboratory’s practice. Recommended reference sources are updated, with especially emphasizing to adapt lower limit of normal (LLN) or z score instead of percent of prediction to estimate the abnormal results. This document provides detail and clear explanation on the recommendations, which might improve the interpretation, communication, and understanding of test results. However, parts of recommendation might not be used directly in our clinical practice owing to some specific conditions in China. We suggest to use appropriate normal predictions from Chinese population, to include small airway parameters such as mid-maximal expiratory flow for early detection of pulmonary function deterioration, and to include inspiratory flow volume curve, as well as strengthen the quality control data and figures in the report format.

关键词: 肺功能; 标准化; 报告; 正常预计值; 质量控制; 美国胸科学会(ATS)

Key words: Pulmonary function; Standardization; Report; Normal reference; Quality control; American Thoracic Society (ATS)

引用本文: 郑劲平, 梁晓林. “美国胸科学会推荐的标准化肺功能报告”之解读和商榷. 中国循证医学杂志, 2018, 18(3): 249-253. doi: 10.7507/1672-2531.201801130 复制

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