不同评价指标在慢性阻塞性肺疾病患者综合评估中的应用

发布时间：2017-12-31 19:01

本文关键词：不同评价指标在慢性阻塞性肺疾病患者综合评估中的应用　出处：《中国全科医学》2016年05期 　论文类型：期刊论文

【摘要】：目的应用圣乔治呼吸问卷(SGRQ)、慢性阻塞性肺疾病临床呼吸问卷(CCQ)、慢性阻塞性肺疾病临床测试量表(CAT)、改良英国医学研究理事会呼吸困难指数(m MRC)与6分钟步行试验(6MWT)评价慢性阻塞性肺疾病(COPD)患者健康状况、呼吸困难程度和运动耐力,并分析其评分结果与COPD患者肺功能参数第1秒用力呼气末容积占预计值百分比(FEV1%pred)的相关性,探讨其在临床中的应用价值。方法 2014年5—10月苏州大学附属第三医院呼吸内科对常州市永红及魏村地区进行COPD流行病学调查,根据纳入与排除标准筛选出90例COPD患者。对患者进行SGRQ、CAT、m MRC、CCQ、BODE指数评分及6MWT、肺功能检查,综合分析各评分系统之间以及各评分系统与患者肺功能气流受限严重程度的相关性;并将COPD患者按照性别、年龄、有无合并症等进行分组,观察各评分系统用于不同COPD人群的差异性;对患者进行综合评估,了解综合评估COPD患者严重程度的意义。结果90例患者SGRQ总分为(21.9±14.4)分,CAT评分为(17.0±5.9)分,m MRC评分为(1.3±1.2)分,6MWT为(390.7±86.2)m,BODE评分为(2.6±1.7)分。不同性别、年龄、有无吸烟史患者FEV1%pred、CAT评分、m MRC评分、CCQ评分、SGRQ评分、6MWT比较,差异均无统计学意义(P0.05)。有合并症、年加重次数≥2次的COPD患者FEV1%pred、6MWT均分别低于无合并症、年加重次数2次者,CAT评分、m MRC评分、CCQ评分、SGRQ评分均分别高于无合并症、年加重次数2次者,差异有统计学意义(P0.05)。不同GOLD分级患者体质指数(BMI)、SGRQ评分、CAT评分、m MRC评分、CCQ评分、6MWT及年加重次数比较,差异均有统计学意义(P0.05)。COPD患者肺功能(FEV1%pred)与CAT评分、m MRC评分、CCQ评分、SGRQ评分、BODE呈负相关(r=-0.338、-0.703、-0.529、-0.852、-0.837,P0.01);与呼气峰流速(PEF)、6MWT及BMI呈正相关(r=0.869、0.572、0.322,P0.01)。使用CAT评分和m MRC分级对COPD患者进行综合评估,结果显示,对于高风险患者两种评估方法得到的评估结果一致(Kappa=0.438,P0.001),对于低风险患者两种评估方法得到的结果存在显著差异(P0.05)。本研究也使用CCQ评分对入选患者进行综合评估,结果显示其在低风险患者中与使用CAT评分分组较一致(Kappa=0.753,P0.001)。结论四种呼吸问卷(SGRQ、CAT、m MRC、CCQ)、6MWT、BODE均与肺功能(FEV1%pred)显著相关,可以将其作为肺功能检查的补充,在COPD的临床管理工作中有一定的应用价值。
[Abstract]:The purpose of application of St Georges Respiratory Questionnaire (SGRQ), a clinical questionnaire of chronic obstructive pulmonary disease and respiratory (CCQ), chronic obstructive pulmonary disease clinical test scale (CAT), modified British Medical Research Council dyspnea index (m MRC) and 6 minutes walk test (6MWT) evaluation of chronic obstructive pulmonary disease (COPD) health status of the patients, degree of dyspnea and exercise endurance, and analyze the evaluation results with COPD pulmonary function parameters of the forced expiratory volume percentage of predicted value (FEV1%pred) correlation, to explore the application value in clinical value. The Third Hospital Affiliated to Soochow University from 5 to October 2014 COPD epidemiological survey in Changzhou Yonghong and Wei Village area, according to the inclusion and exclusion criteria, 90 COPD patients were selected. SGRQ, m MRC, in patients with CAT, CCQ, BODE and 6MWT index score, pulmonary function test, a comprehensive analysis of the score The correlation between the system and the scoring system and pulmonary function in patients with airflow obstruction severity; and COPD patients according to gender, age, with or without complications such as group, observe the scoring system for different COPD groups; comprehensive evaluation of the patients, the solution of COPD comprehensive evaluation of severity in patients with the results. 90 cases of patients with SGRQ score (21.9 + 14.4), CAT score (17 + 5.9), m MRC score (1.3 + 1.2), 6MWT (390.7 + 86.2) m, BODE score was (2.6 + 1.7). Gender, age, smoking history of patients with FEV1%pred m, CAT score, MRC score, CCQ score, SGRQ score, 6MWT, there were no significant differences (P0.05). The complications, year increased more than 2 times with COPD FEV1%pred, 6MWT were lower than those without complications, increase the number of years for 2 times, CAT score, m MRC score, CCQ score, SGRQ score were higher than No complications, increase the number of years for 2 times, the difference was statistically significant (P0.05). The levels of GOLD in patients with body mass index (BMI), SGRQ score, CAT score, m MRC score, CCQ score, 6MWT and the number of years increased, the differences were statistically significant (P0.05) in patients with lung function (FEV1%pred) and.COPD CAT score, m MRC score, CCQ score, SGRQ score was negatively correlated with BODE (r=-0.338, -0.703, -0.529, -0.852, -0.837, P0.01) and peak expiratory flow rate; (PEF), 6MWT and BMI were positively correlated (r=0.869,0.572,0.322, P0.01). Using the CAT score and m MRC classification by the synthetic evaluation of COPD the patients showed that the evaluation results for two kinds of assessment methods of high risk patients (Kappa=0.438, P0.001), there was significant difference for the two kinds of evaluation methods of low risk patients (P0.05). The results of this study also used the CCQ score to evaluate the patients, the results showed the low With the use of CAT risk in patients with relatively consistent scores (Kappa=0.753, P0.001). Conclusion the four Respiratory Questionnaire (SGRQ, CAT, m, MRC, CCQ), 6MWT, BODE and lung function (FEV1%pred) were significantly correlated, can be used as a supplement of the pulmonary function tests, have certain application value in clinical management COPD.

【作者单位】：苏州大学附属第三医院呼吸内科;
【基金】：江苏省前瞻性研究专项基金项目(BE2013629)
【分类号】：R563.9
【正文快照】： Application of Different Evaluation Indexes in the Comprehensive Assessment of Patients With Chronic ObstructivePulmonary Disease DU Xiao-qiu,ZHOU Jun,ZHANG Qiu-di.Department of Respiratory Diseases,the Third AffiliatedHospital of Soochow University,Chan

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