<br>吸气性湿啰音——早期和晚期——重新审视：通过湿啰音特征识别慢性阻塞性肺病,BMJ Open Respiratory Research

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吸气性湿啰音——早期和晚期——重新审视：通过湿啰音特征识别慢性阻塞性肺病
BMJ Open Respiratory Research ( IF 3.6 ) Pub Date : 2021-03-01 , DOI: 10.1136/bmjresp-2020-000852
Hasse Melbye ₁ , Juan Carlos Aviles Solis ₂ , Cristina Jácome ₃ , Hans Pasterkamp ₄

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背景 Nath 和 Capel 在 1974 年描述了肺部爆裂声的重要性，根据其在吸气期间发生的时间，早期爆裂声与支气管阻塞相关，晚期爆裂声与限制性缺陷相关。裂纹也被描述为“细”或“粗”。我们的目的是评估爆裂声特征在诊断慢性阻塞性肺疾病（COPD）中的有用性。方法在一项基于人群的研究中，在 6 个听诊部位记录肺音，并对 40 岁或以上的参与者进行分类。两名观察者将吸气爆裂音分为“早期”或“晚期”以及“粗”和“细”类型。 COPD 的诊断基于呼吸道症状和 1 秒用力呼气量/用力吸气肺活量低于正常下限（基于全球肺功能倡议 2012 年参考）。通过逻辑回归分析裂纹特征与 COPD 之间的关联。 Kappa 统计用于评估观察者间的一致性。结果在分析中纳入的 3684 名受试者中，52.9% 为女性，50.1% ≥65 岁，204 名 (5.5%) 患有慢性阻塞性肺病。观察者 1 听到 306 名参与者的基础吸气爆裂音，观察者 2 听到 323 名参与者的基础吸气爆裂音。当双侧听到时，可以预测 COPD，OR 为 2.59（95% CI 1.36 至 4.91）和 3.20（95% CI 1.71 至 5.98），注释为观察者1和观察者2分别根据性别和年龄进行调整。如果双侧爆裂音较粗，则相应的 OR 为 2.65（95% CI 1.28 至 5.49）和 3.67（95% CI 1.58 至 8.52），当吸气早期听到时，OR 为 6.88（95% CI 2.59 至 18.29）和 7.63（95 %CI 3.73 至 15.62）。当一侧或双肺听到早期爆裂音时，COPD 的阳性预测值为 23%。我们在对时间进行分类时观察到比类型分类时更高的 kappa 值。结论“早期”吸气爆裂音比“粗”吸气爆裂音更能预测 COPD。识别肺基部的早期湿啰音意味着要高度关注慢性阻塞性肺病的可能性。

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Inspiratory crackles—early and late—revisited: identifying COPD by crackle characteristics

Background The significance of pulmonary crackles, by their timing during inspiration, was described by Nath and Capel in 1974, with early crackles associated with bronchial obstruction and late crackles with restrictive defects. Crackles are also described as ‘fine’ or ‘coarse’. We aimed to evaluate the usefulness of crackle characteristics in the diagnosis of chronic obstructive pulmonary disease (COPD). Methods In a population-based study, lung sounds were recorded at six auscultation sites and classified in participants aged 40 years or older. Inspiratory crackles were classified as ‘early’ or ‘late and into the types’ ‘coarse’ and ‘fine’ by two observers. A diagnosis of COPD was based on respiratory symptoms and forced expiratory volume in 1 s/forced inspiratory vital capacity below lower limit of normal, based on Global Lung Function Initiative 2012 reference. Associations between crackle characteristics and COPD were analysed by logistic regression. Kappa statistics was applied for evaluating interobserver agreement. Results Of 3684 subjects included in the analysis, 52.9% were female, 50.1% were ≥65 years and 204 (5.5%) had COPD. Basal inspiratory crackles were heard in 306 participants by observer 1 and in 323 by observer 2. When heard bilaterally COPD could be predicted with ORs of 2.59 (95% CI 1.36 to 4.91) and 3.20 (95% CI 1.71 to 5.98), annotated by observer 1 and 2, respectively, adjusted for sex and age. If bilateral crackles were coarse the corresponding ORs were 2.65 (95% CI 1.28 to 5.49) and 3.67 (95% CI 1.58 to 8.52) and when heard early during inspiration the ORs were 6.88 (95% CI 2.59 to 18.29) and 7.63 (95%CI 3.73 to 15.62). The positive predictive value for COPD was 23% when early crackles were heard over one or both lungs. We observed higher kappa values when classifying timing than type. Conclusions ‘Early’ inspiratory crackles predicted COPD more strongly than ‘coarse’ inspiratory crackles. Identification of early crackles at the lung bases should imply a strong attention to the possibility of COPD.

更新日期：2021-03-05

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