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| 慢性阻塞性肺疾病评估测试评分与慢性阻塞性肺疾病预后因素相关性分析 |
| 张景熙,胡建军,徐健,赵立军,白冲,李强* |
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| (第二军医大学长海医院呼吸内科,上海 200433*通信作者) |
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| 摘要: |
| 目的 观察慢性阻塞性肺疾病(COPD)评估测试(CAT)评分与COPD患者疾病预后因素的相关性,以探讨CAT评分在判断预后方面的可能价值。方法 选取从2011年7月至2012年9月在我院门诊就诊的81例初诊及既往无使用吸入性糖皮质激素(ICS)/长效β2受体激动剂(LABA)或长效胆碱能药物(LAMA)病史的COPD患者为研究对象,根据2011年版COPD全球倡议指南(GOLD)分为A(低危、症状轻)、B(低危、症状重)、C(高危、症状轻)、D(高危、症状重)组,给予ICS/LABA或ICS/LABA+LAMA治疗,收集患者治疗前及治疗3个月后相关资料,包括CAT评分、年龄、吸烟量、肺功能指标、体质指数(BMI)、运动耐力指标6 min步行距离(6MWD)、改良英国MRC呼吸困难指数(mMRC)及诊断前12个月COPD急性加重(AECOPD)次数,分析患者临床特征并进行相关性分析。结果 81例COPD患者平均年龄(66.27±8.52)岁,男性占88.89%,吸烟者占85.19%；治疗前A、B、C、D组比例分别为8.64%、30.86%、4.94%及55.56%；CAT评分≥10分组一秒用力呼气容积(FEV1)及其占预计值百分比(FEV1%Pred)、用力呼气容积(FVC)及其占预计值百分比(FVC%Pred)、呼气峰流速(PEF)及其占预计值百分比(PEF%Pred)、6MWD均较CAT评分 <10分组降低(P<0.05),CAT评分为10～20分组、20～30分组及≥30分组上述指标间差异无统计学意义。CAT评分≥20分组mMRC分级及AECOPD次数较CAT评分<10分组升高(P<0.05),不同分组间FEV1/FVC差异无统计学意义。CAT评分与mMRC分级(治疗前r2=0.417,P<0.001；治疗后r2=0.19, P<0.001)、6MWD(治疗前r2=0.320,P<0.001；治疗后r2=0.19,P<0.00 1)及治疗前FEV1(r2=0.177,P=0.001 5)、FEV1%Pred(r2=0.125,P=0.002)、PEF(r2=0.164,P=0.002 4)、PEF%Pred(r2=0.129,P=0.007 6)、FVC(r2=0.098,P=0.021)、FVC%Pred(r2=0.094,P=0.024)、FEV1/FVC(r2=0.101,P=0.005 7)、AECOPD次数(r2=0.059,P=0.028)有关，与吸烟量(r2=0.041,P=0.083)、BMI(r2=0.00,P=0.89)及治疗后FEV1(r2=0.01,P=0.22)、FEV1%Pred(r2=0.003,P=0.09)无关。结论 COPD好发于男性吸烟者,其中D组比例最高。CAT评分与治疗前后mMRC分级及运动耐力指标相关性均较好,具有判断COPD患者预后的潜在价值。 |
| 关键词: 慢性阻塞性肺疾病 慢性阻塞性肺疾病评估测试 预后 呼吸功能试验 |
| DOI： |
| 投稿时间：2013-03-21修订日期：2013-05-02 |
| 基金项目:国家自然科学基金(81100017). |
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| Relationship between chronic obstructive pulmonary disease (COPD) assessment test score and prognostic factors of COPD patients |
| ZHANG Jing-xi,HU Jian-jun,XU Jian,ZHAO Li-jun,BAI Chong,LI Qiang* |
| (Department of Respiratory Diseases, Changhai Hospital, Second Military Medical University, Shanghai 200433, China*Corresponding author.) |
| Abstract: |
| Objective To observe the correlation between chronic obstructive pulmonary disease (COPD) assessment test(CAT) score and prognostic factors, so as to investigate the value of CAT score in predicting the prognosis of COPD. Methods A total of 81 patients with newly diagnosed COPD in our hospital during Jul.2011 to Sep.2012, without using inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) or long-acting antimuscarinic agent (LAMA), were divided into group A (low risk, less symptoms), B (low risk, more symptoms), C (high risk, less symptoms) and D (high risk, more symptoms) groups according to Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2011 edition), and the patients were given ICS/LABA or ICS/LABA+LAMA treatment for 3 months. The CAT score, age, smoking quantity, pulmonary function indices, body mass index (BMI), 6-min walking distance (6MWD), modified medical British research council (mMRC) dyspnea scale, and the times of acute exacerbation of COPD (AECOPD) in previous one year were collected before and after treatment. The clinical characteristics analysis and correlation analysis were performed. Results The average age of the 81 COPD patients was (66.27±8.52) years, with 88.89% being males and 85.19% having smoking history. The proportions of group A, B, C and D were 8.64%, 30.86%, 4.94% and 55.56% before treatment, respectively. The values of the forced expiratory volume in one second (FEV1), predicted amount as a percentage of FEV1 (FEV1%Pred), forced vital capacity (FVC), predicted amount as a percentage of FVC (FVC%Pred), peak expiratory flow (PEF), predicted amount as a percentage of PEF (PEF%Pred), and 6MWD in CAT score ≥10 groups were significantly less than those in CAT score<10 group (P<0.05). The above parameters were not significantly different between patients with CAT score being 10-20, 20-30 and ≥30 groups. mMRC scale and times of AECOPD in CAT score ≥20 groups were significantly higher than those in CAT score<10 group (P<0.05). No significant difference in FEV1/FVC was found in different CAT score groups. The CAT score was significantly correlated with mMRC scale (pre-treatment r2=0.417, P<0.001; post-treatment r2=0.19, P<0.001), 6MWD (pre-treatment r2=0.320, P<0.001；post-treatment r2=0.19, P<0.001), pre-treatment FEV1 (r2=0.177, P=0.001 5), FEV1%Pred(r2=0.125, P=0.002), PEF(r2=0.164, P=0.002 4), PEF%Pred (r2=0.129, P=0.007 6), FVC (r2=0.098, P=0.021), FVC%Pred (r2=0.094, P=0.024), FEV1/FVC(r2=0.101, P=0.005 7), and AECOPD number (r2=0.059, P=0.028); and not correlated with the quantity of smoking (r2=0.041, P=0.083), BMI (r2=0.00, P=0.89), and post-treatment FEV1(r2=0.01, P=0.22) or FEV1%Pred (r2=0.003, P=0.09).Conclusion COPD is prone to occur in the male smokers, with the highest proportion found in group D. CAT score has a good correlation with pre- and post-treatment mMRC scale and exercise capacity, suggesting it has a potential for predicting prognosis of COPD. |
| Key words: chronic obstructive pulmonary disease chronic obstructive pulmonary disease assessment test prognosis respiratory function test |
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