老年慢性阻塞性肺疾病患者一氧化碳弥散与肺通气功能的相关性研究

doi:10.3877/cma.j.issn.1674-6902.2026.04.017

目的

分析老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者一氧化碳弥散功能(diffusing capacity of the lungs for carbon monoxide, DLCO)与肺通气功能的相关性，评估DLCO、DLCO%pred、DLCO/VA在诊断中的意义及差异。

方法

纳入2022年6月至2024年6月苏北人民医院完成肺功能及胸部CT检查的老年患者535例，其中COPD患者为观察组275例，无呼吸道疾病患者260例为对照组。收集人口学资料、肺功能指标及CT肺气肿指数(LAA%)。采用Pearson相关分析探讨DLCO与通气功能的相关性，多因素线性回归分析DLCO%pred的影响因素，并通过ROC曲线评估诊断效能。

结果

观察组FEV₁(1.23±0.48)L、FVC(2.33±0.70)L、FEV1%pred(50.40±20.92)、DLCO(3.46±1.57)mmol/min/kPa、DLCO%pred(45.17±21.35)、DLCO/VA(0.74±0.35)mmol/min/kPa/L低于对照组FEV₁(2.33±0.65)L、FVC(2.98±0.81)L、FEV1%pred(104.04±21.69)、DLCO(5.53±1.81)mmol/min/kPa、DLCO%pred(74.68±21.37)、DLCO/VA(1.81±0.29)mmol/min/kPa/L(P<0.05)；观察组LAA%(18.37±7.13)高于对照组(1.32±0.38)(P<0.05)。DLCO%pred与FEV1%pred呈显著正相关(r＝0.708，P<0.01)。多因素回归显示，年龄、FEV1%pred及LAA%是DLCO%pred的影响因素(P<0.01)。DLCO%pred诊断COPD的整体AUC为0.844 (0.799~0.889)，性别分层后诊断价值提升，男性DLCO%pred最佳截断值为59.75%，AUC＝0.883(0.842~0.924)，女性为65.50%，AUC＝0.861(0.778~0.943)。

结论

DLCO指标与肺通气功能及肺气肿程度密切相关，对老年COPD患者具有辅助诊断意义。基于性别分层的诊断阈值能进一步优化筛查准确性。年龄、通气功能损害程度及肺气肿严重程度是影响老年患者弥散功能的影响因素。

关键词: 肺疾病，慢性阻塞性, 老年患者, 呼吸功能试验, 一氧化碳弥散功能, 诊断意义

Objective

To analyze the correlation between diffusing capacity for carbon monoxide (DLCO) and pulmonary ventilation function in elderly patients with chronic obstructive pulmonary disease (COPD), and to evaluate the diagnostic performance of DLCOrelated indicators with emphasis on sexspecific differences.

Methods

In this casecontrol study, 535 elderly patients (age ≥60 years) who underwent pulmonary function tests and chest CT between June 2022 and June 2024 were enrolled and classified into a COPD group 275 cases and a control group 260 cases according to the GOLD criteria. Collected data included demographics, spirometric parameters (FEV₁, FEV1%pred, FVC, FEV₁/FVC), DLCOrelated measures (DLCO, DLCO%pred, DLCO/VA), and CTderived emphysema index (LAA%). Pearson correlation and multivariate linear regression were used to assess associations and independent predictors of DLCO%pred. Diagnostic performance was evaluated using receiveroperatingcharacteristic (ROC) curves.

Results

Compared with controls, the COPD group showed significantly lower values in all DLCOrelated and spirometric indices (all P<0.05). DLCO%pred was strongly correlated with FEV1%pred (r=0.708, P<0.01). Multivariate analysis identified age, FEV1%pred, and LAA% as independent determinants of DLCO%pred (all P<0.01). The overall AUC of DLCO%pred for diagnosing COPD was 0.844 (95%CI: 0.799~0.889). Sexspecific cutoffs improved diagnostic accuracy: in males, DLCO%pred ≤59.75% yielded an AUC of 0.883 (95%CI: 0.842~0.924); in females, ≤65.50% yielded an AUC of 0.861 (95%CI: 0.778~0.943).

Conclusion

DLCOrelated indices correlate closely with ventilatory impairment and emphysema severity in elderly COPD patients and provide valuable diagnostic information. Sexstratified thresholds can enhance screening accuracy and support a more individualized assessment approach.

Key words: Chronic obstructive pulmonary disease, Elderly patients, Respiratory function test, Diffusion capacity for carbon monoxide, Diagnosis significance

表1 两组血红蛋白、LAA%及肺功能指标比较

临床指标	观察组(n＝275)	对照组(n＝260)	t值	P值
血红蛋白[g/dl，(±s)]	14.61±2.52	14.92±1.93	1.591	0.112
LAA%(±s)	18.37±7.13	1.32±0.38	－38.505	0.000
FEV₁[L，(±s)]	1.23±0.48	2.33±0.65	22.349	0.000
FVC[L，(±s)]	2.33±0.70	2.98±0.81	9.947	0.000
FEV1%pred(±s)	50.40±20.92	104.04±21.69	29.116	0.000
DLCO[mmol/min/kPa，(±s)]	3.46±1.57	5.53±1.81	14.152	0.000
DLCO%pred(±s)	45.17±21.35	74.68±21.37	15.972	0.000
TLC[L，(±s)]	4.80±1.04	4.79±0.94	－0.116	0.907
DLCO/VA[mmol/min/kPa/L，(±s)]	0.74±0.35	1.81±0.29	38.386	0.000

表1 两组血红蛋白、LAA%及肺功能指标比较

临床指标	观察组(n＝275)	对照组(n＝260)	t值	P值
血红蛋白[g/dl，(±s)]	14.61±2.52	14.92±1.93	1.591	0.112
LAA%(±s)	18.37±7.13	1.32±0.38	－38.505	0.000
FEV₁[L，(±s)]	1.23±0.48	2.33±0.65	22.349	0.000
FVC[L，(±s)]	2.33±0.70	2.98±0.81	9.947	0.000
FEV1%pred(±s)	50.40±20.92	104.04±21.69	29.116	0.000
DLCO[mmol/min/kPa，(±s)]	3.46±1.57	5.53±1.81	14.152	0.000
DLCO%pred(±s)	45.17±21.35	74.68±21.37	15.972	0.000
TLC[L，(±s)]	4.80±1.04	4.79±0.94	－0.116	0.907
DLCO/VA[mmol/min/kPa/L，(±s)]	0.74±0.35	1.81±0.29	38.386	0.000

表2 肺弥散功能与通气功能指标相关性分析(r)

相关参数	FEV₁	FVC	FEV₁/FVC	FEV₁ pred	LAA%	年龄
DLCO	0.759^a	0.651^a	0.589^a	0.590^a	－0.308^a	－0.379^a
DLCO%pred	0.675^a	0.503^a	0.662^a	0.708^a	－0.460^a	－0.255^a
DLCO/VA	0.610^a	0.428^a	0.658^a	0.603^a	－0.396^a	－0.348^a
TLC	0.388^a	0.546^a	－0.072	0.089	0.163	－0.238^a
TLC%pred	0.354^a	0.289^a	0.122	0.574^a	0.159	－0.153^b

表2 肺弥散功能与通气功能指标相关性分析(r)

相关参数	FEV₁	FVC	FEV₁/FVC	FEV₁ pred	LAA%	年龄
DLCO	0.759^a	0.651^a	0.589^a	0.590^a	－0.308^a	－0.379^a
DLCO%pred	0.675^a	0.503^a	0.662^a	0.708^a	－0.460^a	－0.255^a
DLCO/VA	0.610^a	0.428^a	0.658^a	0.603^a	－0.396^a	－0.348^a
TLC	0.388^a	0.546^a	－0.072	0.089	0.163	－0.238^a
TLC%pred	0.354^a	0.289^a	0.122	0.574^a	0.159	－0.153^b

表3 影响DLCO%pred的多元线性回归分析(逐步法)

变　量	β系数(95%CI)	标准误	标准化β系数	t值	P值
常量	89.874(78.312 ，101.436)	5.752	－	15.621	0.001
年龄	－0.497(－0.768，－0.226)	0.137	－0.142	－3.621	0.001
FEV1%pred	0.641(0.542，0.740)	0.051	0.503	12.589	0.001
LAA%	－1.856(－2.360，－1.352)	0.255	－0.288	－7.285	0.001

表3 影响DLCO%pred的多元线性回归分析(逐步法)

变　量	β系数(95%CI)	标准误	标准化β系数	t值	P值
常量	89.874(78.312 ，101.436)	5.752	－	15.621	0.001
年龄	－0.497(－0.768，－0.226)	0.137	－0.142	－3.621	0.001
FEV1%pred	0.641(0.542，0.740)	0.051	0.503	12.589	0.001
LAA%	－1.856(－2.360，－1.352)	0.255	－0.288	－7.285	0.001

图1 DLCO%pred、DLCO/VA、DLCO诊断老年慢阻肺病的ROC曲线。图A为整体人群DLCO%pred、DLCO/VA、DLCO诊断老年COPD的ROC曲线；图B为男性患者DLCO%pred、DLCO/VA、DLCO诊断老年COPD的ROC曲线；图C为女性患者DLCO%pred、DLCO/VA、DLCO诊断老年COPD的ROC曲线

表4 肺弥散功能指标对老年COPD患者的诊断价值(整体与性别分层)

分　层	指　标	AUC(95%CI)	截断值	灵敏度	特异度
整体	DLCO%pred	0.844(0.799~0.889)	63.50	0.793	0.804
	DLCO/VA	0.839(0.794~0.884)	1.005	0.766	0.814
	DLCO	0.816(0.768~0.864)	4.455	0.786	0.765
男性	DLCO%pred	0.883(0.842~0.924)	59.75	0.849	0.781
	DLCO/VA	0.859(0.814~0.904)	0.875	0.919	0.679
	DLCO	0.873(0.829~0.917)	4.820	0.826	0.815
女性	DLCO%pred	0.861(0.778~0.943)	65.50	0.852	0.769
	DLCO/VA	0.849(0.764~0.933)	1.105	0.830	0.778
	DLCO	0.826(0.733~0.918)	4.430	0.732	0.917

表4 肺弥散功能指标对老年COPD患者的诊断价值(整体与性别分层)

分　层	指　标	AUC(95%CI)	截断值	灵敏度	特异度
整体	DLCO%pred	0.844(0.799~0.889)	63.50	0.793	0.804
	DLCO/VA	0.839(0.794~0.884)	1.005	0.766	0.814
	DLCO	0.816(0.768~0.864)	4.455	0.786	0.765
男性	DLCO%pred	0.883(0.842~0.924)	59.75	0.849	0.781
	DLCO/VA	0.859(0.814~0.904)	0.875	0.919	0.679
	DLCO	0.873(0.829~0.917)	4.820	0.826	0.815
女性	DLCO%pred	0.861(0.778~0.943)	65.50	0.852	0.769
	DLCO/VA	0.849(0.764~0.933)	1.105	0.830	0.778
	DLCO	0.826(0.733~0.918)	4.430	0.732	0.917

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Study on the correlation between diffusion capacity for carbon monoxide and pulmonary ventilation function in elderly patients with chronic obstructive pulmonary disease

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Study on the correlation between diffusion capacity for carbon monoxide and pulmonary ventilation function in elderly patients with chronic obstructive pulmonary disease