GOLD 2011与 GOLD 2006文件在 COPD 病情评估和药物推荐异同及医生依从性分析

Similarity and difference in COPD evaluation and medicine suggestion in GOLD 2011 an d GOLD 2006 documents and pulmonologis＇s compliance

目的：比较慢性阻塞性肺疾病全球倡议（ GOLD）2011与2006文件在慢性阻塞性肺疾病（ COPD）病情评估、药物推荐的异同；了解呼吸科医师对GOLD 2011药物治疗建议的依从性。方法将224例COPD稳定期患者分别依据GOLD 2011与2006文件进行病情评估，并比较两种文件在病情评估、药物推荐方面的异同及探讨医生对文件的依从性。结果⑴按GOLD 2006文件病情评估，Ⅳ级患者38例（16．97％），按GOLD 2011文件，D组患者147例（65．62％），二者比较差异有统计学意义（ P ＜0．01）。⑵按肺功能与过去急性加重次数对急性加重的风险评估比较差异有统计学意义（ P ＜0．01）。⑶慢阻肺评估测试问卷（CAT）与改良版英国医学研究会呼吸问卷（mMRC）评分对症状轻重的判定比较差异有统计学意义（ P ＜0．01） ， CAT 与 mMRC 评分一致程度中等（ k ＝0．466）。⑷GOLD 2011建议患者使用吸入长效支气管舒张剂224例（100％）高于GOLD 2006文件（213例，95．18％）（ P ＜0．01）；⑸与GOLD 2011治疗药物建议相一致的处方占161例（71．9％），高于与GOLD 2006推荐药物治疗相一致的处方（120例，53．6％）（ P ＜0．01）。结论⑴相比GOLD 2006，GOLD 2011文件使患者分布集中在病情最重的组别。⑵气流受限严重程度和过去急性加重次数对患者急性加重风险的评估不一致；CAT和mMRC评分对患者症状的判定不相同。⑶GOLD 2011推荐使用长效支气管舒张剂的范围更加广泛。⑷教学医院呼吸科医师对GOLD 2011的药物治疗依从性不理想。

Objective To investigate the similarity and difference in chronic obstructive pulmonary disease （ COPD） evaluation and drug selection that were compared between global initiative for chronic ob-structive lung disease （GOLD） 2011 and GOLD 2006, and to explore treatment adherence by doctors ac-cording to GOLD 2011.M ethods We collected 224 patients with COPD from Department of Respiratory Medicine at the Second Xiangya Hospital to investigate the differences in COPD evaluation and drug selec-tion according to GOLD 2011 and GOLD 2006 with treatment adherence by doctors according to GOLD 2011.Results ⑴According to GOLD 2006, there were 38 patients in the most severe stage, which was different from that （Group D, 147） according to GOLD 2011 （ P 〈0.01）.⑵The risk stratification by u-sing pulmonary function assessment was significantly different from that by using exacerbation history.⑶Symptom assessment by using COPD assessment test （ CAT） was significantly different from that by using modified British medical research council （ mMRC） .The kappa coefficient of these two questionnaires was 0.466, suggesting moderate agreement.⑷ According to GOLD 2011, 224 （100%） patients were recom-mended to use inhaled long-acting bronchodilators, which was higher than that （213, 95.18%） according＆amp;nbsp;to GOLD2006 （ P 〈0.01）.⑸The level of appropriated actual prescription was 161 （71.9%） according to GOLD 2011, which was significantly different from that （120,53.1%） according to GOLD 2006 （ P 〈0.01）.Conclusions ⑴ Compared to GOLD 2006, GOLD 2011 categorized more patients into the most severe group.⑵The risk stratification of COPD by airflow limitation severity or exacerbation risk was not i-dentical.Discordance between CAT and mMRC was observed.⑶GOLD 2011 recommends a wider range of using long-acting bronchodilators.⑷The adherence to GOLD guideline in our hospital is still far from satis-faction.