慢性阻塞性肺疾病患者短期生活质量改变与第1秒用力呼气容积改变之间的关系研究

Relationship of the changes between short-term life quality and forced expiratory volume in one second of pulmonary function in COPD patients

目的通过研究慢性阻塞性肺疾病(简称慢阻肺)患者短期健康相关生活质量评估变化与肺功能第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))改善/恶化的关系,探讨通过评估患者生活质量变化来规划其肺功能评估频次的可行性。方法选择2020年至今重庆北部宽仁医院慢性气道疾病管理中心标准化慢阻肺和哮喘管理项目数据库及其扩展库中诊断慢阻肺,并完成有间隔28 d的两次肺功能检测和圣乔治呼吸问卷(Saint George’s Respiratory Questionnaire,SGRQ)的患者。根据前后28天肺通气功能测试中FEV_(1)改变量(△FEV_(1))的不同,分为△FEV_(1)改善组、△FEV_(1)恶化组和△FEV_(1)维持组,分析不同△FEV_(1)分组患者SGRQ问卷得分均值差异,△FEV_(1)恶化分组的高危因素和神经网络分析影响△FEV_(1)恶化的各影响因素重要程度。结果1233例患者信息被纳入分析,各△FEV_(1)分组之间△SGRQ总分、△SGRQ症状、△SGRQ活动和△SGRQ影响评分均有统计学差异(均P<0.05)。△FEV_(1)改善组无论在SGRQ总分还是各个分部得分中,均显示出相对于△FEV_(1)维持组具有临床意义的改善,改善值均大于4分。而△FEV_(1)恶化组尽管在SGRQ总分和各分部得分中显示出有统计学差异,但是仅在SGRQ症状分部评估中显示出临床意义的恶化。Logistic回归模型提示影响△FEV_(1)恶化的高危因素包括女性(OR=2.11,95%CI 1.23~3.59,P=0.006),基线FEV_(1)(OR=2.63,95%CI 1.92~3.60,P<0.001),△SGRQ(OR=1.02,95%CI 1.01~1.03,P<0.001),基线SGRQ症状(OR=1.02,95%CI 1.01~1.02,P<0.001)和△SGRQ症状(OR=1.02,95%CI 1.01~1.03,P<0.001),进一步神经网络分析5个变量的重要性排序分别是△SGRQ总分(100.0%)、△SGRQ症状(86.9%),基线FEV_(1)(71.4%),基线SGRQ症状(56.6%)和性别(29.6%)。结论慢阻肺患者短期健康相关生活质量评估变量有利于预测肺功能改善变化,但对肺功能恶化变化的预测能力有限。对于短期健康相关生活质量评估没有变化、甚至改善的患者依然建议增加肺功能监测频次,以便早期发现肺功能恶化。

Objective To study the relationship between the changes of short-term health-related life quality and the improvement/deterioration of forced expiratory volume in one second(FEV_(1))in patients with chronic obstructive pulmonary disease(COPD),and explore the feasibility of planning the frequency of pulmonary function test by evaluating the changes of life quality of COPD patients.Methods Based on the change of FEV_(1)(△FEV_(1)),COPD patients from the standardized COPD and asthma management project database and its extended database of the center for chronic airway disease management,from 2020 to now,who completed pulmonary function tests and St.George’s Respiratory Questionnaire(SGRQ)twice with an interval of 28 days,were divided into△FEV_(1)improvement group,△FEV_(1)deterioration group and△FEV_(1)maintenance group.The differences of SGRQ scores in different△FEV_(1)groups were analyzed,and the high-risk factors of△FEV_(1)deterioration group and the importance of influencing factors of△FEV_(1)deterioration were analyzed by neural network.Results A total of 1233 patients were included in the analysis.There were significant differences in△SGRQ total score,△SGRQ symptom,△SGRQ activity and△SGRQ impacts among△FEV_(1)groups(P<0.05).Compared with the△FEV_(1)maintenance group,the△FEV_(1)improvement group showed clinically significant improvement in both the total SGRQ score and each sub score,and the improvement value was more than 4 points.While the△FEV_(1)deterioration group showed statistically significant difference in the total SGRQ score and each sub score,but only showed clinically significant deterioration in the SGRQ symptom sub evaluation.Logistic regression model showed that the risk factors of△FEV_(1)deterioration included female(OR=2.11,95%CI 1.23-3.59,P=0.006),baseline FEV_(1)(OR=2.63,95%CI 1.92-3.60,P<0.001),△SGRQ(OR=1.02,95%CI 1.01-1.03,P<0.001),baseline SGRQ symptom(OR=1.02,95%CI 1.01-1.02,P<0.001)and△SGRQ symptom(OR=1.02,95%CI 1.01-1.03,P<0.001),further neural network analysis showed that the importance orders of the five variables were△SGRQ total score(100.0%),△SGRQ symptom(86.9%),baseline FEV_(1)(71.4%),baseline SGRQ symptom(56.6%)and gender(29.6%).Conclusions The variables of short-term health-related life quality assessment of COPD patients are helpful to predict the changes of pulmonary function improvement,but the ability to predict the changes of pulmonary function deterioration is limited.For patients with no changes or improvement in short-term health-related life quality assessment,it is still recommended to increase the frequency of pulmonary function test in order to detect the deterioration of pulmonary function early.