从GOLD 2019评估工具的重要更新看慢性阻塞性肺疾病诊断和治疗的变化

Change of diagnosis and treatment of COPD from the important update of GOLD 2019 evaluation tool

目的本研究通过分别使用慢性阻塞性肺疾病全球倡议(GOLD)2016、2017以及2019评估工具对慢性阻塞性肺疾病(以下简称"慢阻肺")患者进行病情评估分组,探讨GOLD 2019与GOLD 2016、2017之间的差异,并分析其带来的意义。方法选取2019年6月至2019年10月就诊于我院的97例慢阻肺稳定期患者,按照三种不同评估工具的要求对入选者进行评估分组。结果 1.与GOLD 2016评估工具相比,GOLD 2017、2019使四分之一的患者分组发生降级。2.在推荐治疗方案方面,与GOLD 2016评估工具相比,GOLD 2017、2019推荐使用长效支气管舒张剂的患者人数比例增加,而推荐使用吸入性糖皮质激素的患者人数比例在逐年减少。结论 1.通过三种不同的慢阻肺综合评估工具对慢阻肺患者进行评估,我们发现GOLD 2019的分组使更多患者从高风险组降为低风险组,从而使药物治疗方案发生降级,有助于减少患者的药物治疗费用。2.在推荐用药方面,使用长效支气管舒张剂适用人群范围扩大,而使用吸入性糖皮质激素的适用人群范围缩小,用药尺度把握得更加谨慎和精确。

Objective To explore the differences between GOLD 2019 and GOLD 2016 and 2017, and to analyze its significance by using GOLD 2016, 2017 and 2019 GOLD respectively to assess the disease situation of COPD patients. Methods From June 2019 to October 2019, 97 patients with COPD in stable stage were selectedand divided into three groups according to the requirements of three different evaluation tools. Results 1. Compared with the GOLD 2016 evaluation tool,the grade of COPD patients reduced one quarter by Gold 2017 and 2019. 2. In terms of recommended treatment options,compared with GOLD 2016 evaluation tool,the proportion of patients recommended to use long-acting bronchodilators increased in GOLD 2017 and 2019,while the proportion of patients recommended to use inhaled glucocorticoids decreased year by year. Conclusion 1. Through the three different comprehensive assessment tools for COPD patients,it finds that GOLD 2019 can reduce more patients from the high-risk group to the low-risk group,so that the drug treatment plan is degraded,which is helpful to reduce the cost of drug treatment. 2. In the aspect of drug recommendation,the scope of application of long-acting bronchodilator is expanded,while the scope of application of inhaled glucocorticoid is narrowed,and the scale of application is more cautious and accurate.