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

Application of Different Evaluation Indexes in the Comprehensive Assessment of Patients With Chronic Obstructive Pulmonary Disease

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(P>0.05)。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(P<0.05)。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(P<0.05)。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,P<0.01);与呼气峰流速(PEF)、6MWT及BMI呈正相关(r=0.869、0.572、0.322,P<0.01)。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,P<0.001),对于低风险患者两种评估方法得到的结果存在显著差异(P<0.05)。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,P<0.001)。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。

Objective To evaluate the health status,dyspnea and exercise endurance in the patients with chronic obstructive pulmonary disease（ COPD） by SGRQ, CCQ, CAT scale, m MRC dyspnea scale,6MWT, and to analyze the correlation between the evaluation results and the percentage of forced expiratory volume in one second in predicted value（ FEV1% pred） and discuss their value in clinical application. Methods From May to October in 2014, a COPD epidemiological investigation project was carried out in Yonghong region and Weicun region in Changzhou by the Department of Respiratory Diseases of the Third Affiliated Hospital of Soochow University. According to inclusion and exclusion criteria,we enrolled 90 COPD patients. SGRQ,CAT scale, m MRC dyspnea scale, CCQ, BODE,6MWT and pulmonary function test were conducted,and comprehensive analysis was made on the correlation among these evaluation systems and between the evaluation systems and the severity of lung airflow limitation. The COPD patients were divided into groups according to gender,age,and whether complications occurred. Results The total score of SGRQ,CAT score,m MRC score,6MWT and BODE of the 90 patients were（ 21. 9 ± 14. 4）,（ 17. 0 ± 5. 9）,（ 1. 3 ± 1. 2）,（ 390. 7 ± 86. 2） m and（ 2. 6 ± 1. 7）. Patients with different gender,age and smoking history were significantly different in FEV1% pred,CAT score,m MRC score,CCQ score,SGRQ score,6MWT,times of aggregation per year（ P 〉0. 05 for all）. Patients with complications and the times of aggregation per year≥2 were lower（ P 〈0. 05） in FEV1% pred and 6MWT and were higher（ P 〈0. 05） in CAT score,m MRC score,CCQ score,SGRQ score and times of aggregation per year than patients without complications and the times of aggregation per year 2. Patients of different GOLD grades were significantly different in BMI,SGRQ score,CAT score,m MRC score,CCQ score,6MWT and times of aggregation per year（ P 〈0. 05 for all）. Pulmonary function（ FEV1% pred） of the patients were negatively correlated with CAT score,m MRC score,CCQ score,SGRQ score and BODE（ r =- 0. 338,- 0. 703,- 0. 529,- 0. 852,- 0. 837; P 0. 01） and were positively correlated with PEF,6MWT and BMI（ r = 0. 869,0. 572,0. 322; P 0. 01）. The comprehensive evaluation of the patients by CAT scale and m MRC dyspnea scale showed that the evaluation results of the two scales for high- risk patients were same（ Kappa = 0. 438,P 0. 001）,but the results for low- risk patients were different（ P 〈0. 05）. The evaluation result of CCQ were same with that of CAT scale for low- risk patients（ Kappa = 0. 753,P 0. 001）.Conclusion The four respiratory questionnaires（ SGRQ, CAT, m MRC and CCQ）,6MWT and BODE are significantly associated with pulmonary function（ FEV1% pred）, and they could be used as an effective complement to lung function examination and have a certain application value in the clinical management of COPD.