EXACT-PRO在评估COPD患者病情严重程度及急性加重风险中的价值

Value of EXACT-PRO in evaluating severity and acute exacerbation risk of COPD patients

目的探讨慢性阻塞性肺疾病(COPD)急性加重工具(EXACT-PRO)在评估COPD患者病情严重程度和急性加重风险中的价值。方法选取2018年5月至2019年5月COPD急性加重期患者150例为研究对象。记录患者急性加重期和稳定期EXACT-PRO评分,对比二者之间的差异;分析EXACT-PRO评分与患者稳定期肺功能严重程度的关系。应用受试者工作特征曲线(ROC曲线)比较EXACT-PRO与COPD评估测试(CAT)、英国改良呼吸困难量表(mMRC)评分对患者1年内频繁急性加重(住院次数2次及以上)的预测效能。结果EXACT-PRO评分急性加重期明显高于稳定期(P<0.001)。稳定期GOLD分级间EXACT-PRO评分差异有统计学意义(P<0.001),EXACT-PRO评分与GOLD分级呈正相关(r=0.437,P<0.001),与FEV1%pred呈负相关(r=-0.423,P<0.001)。EXACT-PRO、CAT、mMRC评分ROC曲线下面积(AUC)分别为0.708、0.771、0.668,截断值分别为25.50、16.50、1.50分,灵敏度分别为64.76%、51.43%、85.71%,特异度分别为73.33%、88.89%、40.00%,EXACT-PRO评分与CAT、mMRC评分AUC无差异(P>0.05)。结论EXACT-PRO在评估COPD患者病情严重程度、量化诊断急性加重的发生及急性加重风险预测中有一定的临床价值。

Objective To explore the value of exacerbations of chronic pulmonary disease tool-patient reported outcome(EXACT-PRO)in evaluating the severity and acute exacerbation risk of the patients with chronic obstructive pulmonary disease(COPD).Methods One hundred and fifty patients with acute exacerbation of COPD from May 2018 to May 2019 were selected as the study subjects.The EXACT-PRO scores of all patients in the acute exacerbation and stable phases were recorded and the differences between them were compared,and the relationship between the EXACT-PRO scores and the severity of lung function in the stable phase was analyzed.The receiver operating characteristic(ROC)curve was applied to compare the predictive efficiencies of EXACT-PRO,COPD assessment test(CAT)and modified British medical research council(mMRC)for frequent acute exacerbations(≥2 hospitalizations)of COPD patients within 1 year.Results The EXACT-PRO score of the acute exacerbation period was significantly higher than that of the stable period(P<0.001);The EXACT-PRO score had statistical difference among the GOLD grades(P<0.001),the EXACT-PRO score was positively correlated with the GOLD grade(r=0.437,P<0.001),and negatively correlated with FEV1%pred(r=-0.423,P<0.001);Area under the curve(AUC)of EXACT-PRO,CAT,and mMRC scores were 0.708,0.771 and 0.668 respectively,the cutoff values were 25.50,16.50 and 1.50 points respectively,the sensitivities were 64.76%,51.43%and 85.71%respectively,the specificities were 73.33%,88.89%and 40.00%respectively.The EXACT-PRO score was not different from AUC of CAT and mMRC scores(P>0.05).Conclusion EXACT-PRO has a certain clinical value in evaluating the severity of COPD patients,quantitatively diagnosing the occurrence of acute exacerbation and predicting the risk of acute exacerbation.