1.Impacts Of Different FEV1.0% Standard As Cut-off Point On The Frequency Of Airway Obstruction In Adult People Of Jinan 2.Preliminary Study On Pectoralis Muscle Area(PMA) In Male Patients With Chronic Obstructive Pulmonary Disease

Impacts of different FEV1.0%standard as cut-off point on the frequency of Airway Obstruction in adult people of midwest area of Shandong.BackgroundObstructive ventilatory disorder(OBD)is the main feature of pulmonary function changes in common obstructive airway diseases such as asthma and COPD.The decreased FEV1/FVC(the ratio between FEV1 and FVC)is the key to the diagnosis of OBD.At present,there are three commonly used values for obstructive ventilation disorders:①FEV1/FVC<the Lower Limit of Normal(LLN)in healthy people;② The percentage of FEV1/FVC measured value in the predicted value is less than 92%(FEV1/FVC<92%pred);(3)FEV1/FVC<70%.The most ideal indicators for the diagnosis of OBD should be consistent with the physiological characteristics of the whole population,with the smallest error reflecting the actual condition of airflow limitation,the lowest "missed diagnosis rate" and "overdiagnosis rate" in different populations,and good repeatability.ObjectiveTo compare the difference in the detection of obstructive ventilation dysfunction(OBD)among adults in central and western Shandong with different values of FEV1/FVC.MethodsThe data of lung function of adults undergoing pulmonary function examination in Qilu Hospital of Shandong University from April 2012 to November 2015 were collected and divided into 6 groups according to age:18-29 year,30-39 year,40-49 year,50-59 year,60-69 year and 70-79 year.The three different value criteria were used to judge the obstructive ventilation dysfunction in this population,and the detection rate of obstructive ventilation dysfunction in the 6 groups of people under different value criteria was calculated.FEV1/FVC<LLN was used as the reference standard to compare the difference in detection rates of the other two values in different age groups.Results1.Lung function data of 70,513 subjects were included in the study,of which 12,963 cases were excluded because they did not meet the inclusion criteria.Finally,lung function data of 57,550 adults meeting the inclusion criteria were included in the analysis,with an average age of 55.36113.63 years,among which 58.1%were males.2.The mean value and LLN of FEV1/FVC were calculated by the 2011 edition of Zhongshan predictive value equation.Compared with FEV1/FVC<LLN,the detection rate of FEV1/FVC<92%pred was higher in all age groups(P<0.001),and the detection rate of 70-79 age group had the largest difference(44.4%VS 47.3%).3.According to the calculation of one second rate LLN based on Zhongshan 2011 predictive value equation,compared with FEV1/FVC<LLN,FEV1/FVC<70%was"missed diagnosis" in the older age group,and the detection rate of both in the 60-69 age group was 42.5%VS 33.6%(P<0.001).The positive rate of both was 44.4%VS 38.1%(P<0.001).Compared with FEV1/FVC<LLN,FEV1/FVC<70%was"overdiagnosed" in the older age group,and the detection rate of both in the 60-69 age group was 26%VS 33.6%(P<0.001).The positive rate of both was 25.4%VS 38.1%(P<0.001).Conclusions1.FEV1/FVC<92%pred was associated with an "overdiagnosis" risk compared with FEV1/FVC<LLN in adults with obstructive ventilation dysfunction in central and western Shandong.2.The calculation of LLN in the population aged 60-79 years in the central and western regions of Shandong by Zhongshan 2011 version of the predicted value formula is relatively high,and its applicability in the population aged 60-79 years still needs to be verified by national big data and multi-center clinical studies.Preliminary study on Pectoral is Muscle Area(PMA)in male patients with chronic obstructive pulmonary diseaseBackgroundMuscle dystrophy is one of the important complications of COPD,which is related to the severity and prognosis of the disease,but it is easy to be ignored in clinical practice.Muscle atrophy diagnosis depends on muscle mass assessment.Previous methods of muscle mass assessment include direct measurement based on MRI,CT and other imaging tools and DXA(Dual Energy X-Ray Ababsorptiometry.),BIA(bioelectricalimpedanceanalysis)and other indirect measuring method.DXA,MRI and other equipment are huge and expensive.BIA method is an indirect measurement,which is easily affected by body water content.In previous studies,CT-based muscle mass assessment has been widely used in the field of COPD.In recent years,quantitative chest CT has become increasingly important in the evaluation of COPD,and a study published in ATS Annals in 2014 suggested that quantitative chest CT can be used to detect Pectoralis major area(PMA).Large-sample,multi-center,prospective cohort studies such as Copdgene have confirmed that this indicator is less affected by systemic exercise and respiration,can better reflect changes in systemic muscle mass,and is helpful for the assessment of muscular atrophy.It is simple and practical,easy to be popularized in clinical practice,and can help respiratory physicians diagnose muscular atrophy.At present,there are few studies on the application of chest muscle test in the field of COPD.ObjectiveTo investigate the clinical significance of PMA in male patients with COPD.MethodsPatients with COPD in stable stage and acute exacerbation stage who were admitted to Qilu Hospital of Shandong University from August 2015 to December 2019 and healthy subjects who underwent physical examination during the same period were enrolled,aged 50-79 years old,and only male.They were divided into three groups according to the age of 50-59,60-69 and 70-79.Clinical characteristics of the patients were recorded,and the emphysema index and PMA of all the enrolled patients were calculated by Chest Imaging Platform,airway inspector and other Chest analysis software.To compare the differences of chest area and specific chest area between the COPD group and the non-COPD group under different age stratification.To compare the relationship between chest muscle area and clinical characteristics in COPD group.Results1.A total of patients were included in the study,including 434 patients in the COPD group and 128 patients in the healthy control group.There were 281 cases of COPD in stable stage,and 153 cases of COPD in hospital due to acute exacerbation.The mean age was 66.7±6.7 years in the COPD group and 65.1±6.7 years in the non-COPD group.2.Stratified by age,there was no significant difference in age and body surface area between the COPD group and the healthy control group;The chest muscle area of COPD group was lower than that of healthy control group(P<0.001).The specific chest muscle area of COPD group was lower than that of healthy control group in all age groups(P<0.05).3.There were 260 patients with emphysematous dominant type and 174 patients with non-emphysematous dominant type.PMA of emphysematous dominant type of copd patients was lower than that of non-emphysematous dominant type(32.00±7.36 VS 37.52±8.51 cm2,P<0.001).4.Correlation between chest muscle area and clinical features of COPD4.1 PMA and VCpred of COPD patients(r=0.290,P<0.001),forced vital capacity FVC pred(r=0.322,p<0.001),FEV1%pred(r=0.297,p<0.001),FEV1/FVC(r=0.225,p<0.001),PEF%pred(r=0.294,p<0.001).4.2 COPD PMA was associated with emphysema,and PMA was negatively correlated with emphysema index(r=-0.387,P<0.001).4.3 PMA of hospitalized patients with acute exacerbation of COPD was positively correlated with serum albumin content at the beginning of admission(r=0.350,P<0.01).The length of hospital stay was negatively correlated with PMA(r=-0.311,P<0.01).Conclusions1.After excluding the influence of age and other factors,the chest muscle area of the 50-79 year-old COPD group was lower than that of the healthy group.2.Muscle atrophy is associated with emphysema in COPD patients.3.Patients with acute exacerbation of COPD complicated with muscular dystrophy may have adverse outcomes such as prolonged hospital stay and malnutrition.