만성췌장염과 감별이 곤란하였던 췌두부암

Abstract

BACKGROUND: Resting pulmonary function tests(PFTs) are routinely used in the evaluation of pulmonary impairment/disability. But the significance of the cardiopulmonary exercise test(CPX) in the evaluation of pulmonary impairment is controvertible. Many experts believe that dyspnea, though a necessary part of the assessment, is not a reliable predictor of impairment. Nevertheless, oxygen requirements of an organis m at rest are different from at activity or exercising, and a clear relationship between resting PFTs and exercise tolerance has not been established in patients with chronic pulmonary disease. As well, the relationship between resting PFTs and dyspnea is complex. To investigate the relationship of dyspnea, Resting PFTs, and CPX, we evaluated the patients of stabilized chronic pulmonary disease with clinical dyspnea rating(baseline dyspnea index, BDI), resting PFTs, and CPX. METHOD: The 50 patients were divided into two groups: non-severe and severe group on basis of results of resting PFTs(by criteria of ATS), CPX(by criteria of ATS or Ortega), and dyspnea rating(by focal score of BDI). Groups were compared with respect to pulmonary function, indices of CPX, and dyspnea rating. RESULTS: 1) According to the criteria of pulmonary impairment with resting PFTs, VO2 max, and focal score of BDI were significantly low in the severe group(p<0.01). According to the criteria of VO2max(ml/kg/min) and VO2max(%), the parameters of resting PFTs, except FEV1, were not significantly different between non-severe and severe(p>0.05). According to focal score(<median), FEV1(%), FVC(%), MVV(%), FEV1/FVC, and VO2max were significantly lower in the severe group(p<0.01). However, in the more severe dyspneic group(focal score<5), only VO2max(ml/kg/min)and VO2max(%) were low(p<0.01). 2) FEV1(%) was correlated with VO2max(%)(r=0.52;,p<0.01), but not predictive of exercise performance. The focal score had the correlation with max WR(%) (r=0.55;p<0.01). 3) Sensitivity and specificity analysis were utilized to compare the different criteria used to evaluate the severity of pulmonary impairment, revealed that the classification would be different according to the criteria used. And focal score for dyspnea showed similar sensitivity and specificity. CONCLUSION: According to these result, resting PFTs were not superior to rating of dyspnea in prediction of exercise performance in patients with chronic pulmonary diseases and less correlative with focal score for dyspnea than VO2 max and max WR. Therefore, if not contraindicated, CPX would be considered to evaluate the severity of pulmonary impairment in patients with chronic pulmonary diseases, including with severe resting PFTs. Current criteria used to evaluate the severity of impairment were insufficient in considering the degree of dyspnea, so new criteria, including the severity of dyspnea, may be necessary.