GOLD2011分类方法对COPD患者评估的初步探索

A preliminary study of the GOLD 2011 classification method in the evaluation of COPD patients

目的应用2011版慢性阻塞性肺疾病全球创议（GOLD）中的COPD分组评估方法与2007版GOLD分级方法进行对比研究，初步了解两种方法对我国COPD患者病情评估可能存在的差异及其预后价值。方法调查2011年1月1日至2012年1月1日期间就诊于北京同仁医院呼吸科，经肺功能检查明确诊断为COPD的245例稳定期患者。收集基本资料，进行肺功能、COPD评估测试（CAT）问卷，并随访1年，了解患者因急性加重就诊次数及死亡情况。所有患者均按照2011版GOLD及2007版GOLD评估方法分别进行分组，比较其GAT评分、急性加重风险及病死率差异。结果①应用2007版分级方法患者主要集中分布于GOLD2级（n=112，45．71％）及GOLD3级（n=103，42．04％）；而应用2011版分组方法患者集中分布于D组（n=152，62．04％）。②2011版各组间病死率及未来一年因AECOPD就诊次数差异均有统计学意义（P〈0．05）。③D组的三个亚组在年龄、CAT评分、未来一年因AECOPD就诊次数及病死率方面差异均具有统计学意义（P〈0．05）。结论在我们的观察病例中，2011版GOLD分类对疾病加重风险及潜在死亡风险的评估优于2007版GOLD。但这一新的评估和分类方法对于临床和预后的普遍意义，仍需大样本前瞻性研究来进一步证实。

Objective To observe whether differences exist between theassessment method of the GOLD 2011 new classification and that of the GOLD 2007 in the evaluation of COPD patients, and to study the applicability of the new classification system in a cohort of Chinese patients. Methods A total of 245 patients with stable COPD visiting the Department of Respiratory Medicine, Beijing Tongren Hospital, from January 1,2011 to January 1,2012 were enrolled. Baseline data,including 6 minute walking distance and CAT score were collected, and pulmonary function test was performed. All patients were followed up for one year. The patients were classified by the assessment system of GOLD 2011 and GOLD 2007 respectively. Baseline data, pulmonary function results,as well as the exacerbation risk and mortality rate were compared among different groups. Results ①Patients were mostly classified as GOLD grade 2 （ n = 112,45.71 %） and grade 3 （ n = 103,42.04%） when evaluated by FEV1 according to the GOLD 2007 grading system, while the patients were mostly classified as group D（ n = 152,62.04 %） by the new combined assessment system of GOLD 2011. ②There were statistical differences in mortality rate and acute exacerbation frequencies between the groups by GOLD 2011 （ P 〈0.05）. ③There were statistically significant differences in age,CAT score,acute exacerbations in the next year and mortality rate among the three subgroups of group D （ P 〈0.05）. Conclusions The new combined assessment of GOLD 2011was better than GOLD 2007 in evaluating the overall status of COPD, and particularly in evaluating the prognosis and potential future risks.