慢性阻塞性肺疾病晨间症状与其他临床特征的关系及相关因素分析

The relationship between morning symptoms and related clinical features in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(简称慢阻肺)晨间症状与其他临床特征之间的关系,寻找影响晨间症状的相关危险因素。方法选取中南大学湘雅二医院呼吸与危重症医学科门诊就诊的153例稳定期慢阻肺患者进行横断面观察性研究。采用慢性阻塞性肺疾病晨间症状量表中文版(COPD-MSD中文版)评估晨间症状,同时进行改良版英国医学研究会呼吸问卷(mMRC)、慢阻肺评估测试问卷(CAT)、临床慢阻肺问卷(CCQ)评分,计算BODEx指数。结果153例慢阻肺患者平均年龄为(59.6±7.6)岁,第1秒用力呼气容积(FEV1)占预计值百分比为(52.0±20.7)%。慢阻肺患者晨间症状评分中位数为31.00分,各慢性阻塞性肺疾病全球倡议(GOLD)分组患者的晨间症状评分存在差异(P<0.001):GOLD A组评分中位数为23.50(20.00~27.25)分,GOLD B组为31.00(26.00~38.00)分,GOLD C组为30.00(23.75~35.75)分,GOLD D组为36.50(27.00~47.50)分。在不同的mMRC、CAT、CCQ评分下,晨间症状评分中位数之间差异具有统计学意义(均P=0.000)。晨间症状评分与FEV1占预计值百分比呈负相关(r=–0.24,P<0.001),与mMRC、CAT、CCQ、BODEx指数评分均呈正相关(r值分别为0.50、0.60、0.53和0.40,均P<0.001)。多重线性回归分析显示CAT评分是与晨间症状评分高低相关的重要因素(B=0.829,P<0.001)。结论晨间症状与评估慢阻肺疾病严重程度的多项临床指标相关,其中健康状况与晨间症状相关程度最高,因此临床评估慢阻肺患者晨间症状对患者病情的综合评估能提供一定帮助。

Objective To explore the relationship between morning symptoms and other clinical characteristics in patients with chronic obstructive pulmonary disease(COPD),and to look for related risk factors affecting morning symptoms.Methods This cross-sectional observational study included 153 patients with stable COPD.Morning symptoms were evaluated with the Chinese-version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary(Ch-COPD-MSD).And modified version of the British medical association respiratory questionnaire(m MRC),COPD assessment test(CAT),questionnaire clinical COPD questionnaire(CCQ)score were scored,and the BODEx index was calculated.Results A total of 153 stable COPD patients were included.The patients aged 59.6±7.6 years with a mean forced expiratory volume in one second of(52.0±20.7)%predicted(FEV1%pred).The median score of morning symptoms was 31.00.Morning symptoms severity was different between GOLD groups A to D:median(interquartile range)score in GOLD A was 23.50(20.00-27.25),in GOLD B was 31.00(26.00-38.00),in GOLD C was 30.00(23.75-35.75),and in GOLD D was 36.50(27.00-47.50)(P<0.001).Meanwhile,under different m MRC,CAT,CCQ scores,the difference in the median score of morning symptoms was statistically significant(all P=0.000).Score of morning symptoms was negatively correlated with the FEV1%pred(r=–0.24,P<0.001),and positively correlated with the score of m MRC,CAT,CCQ,and the BODEx index(r value was 0.50,0.60,0.53,0.40,respectively,P<0.001).Multiple linear regression analysis showed that CAT score was the important factor associated with morning symptoms severity in COPD(B=0.829,P<0.001).Conclusions Morning symptoms are associated with multiple clinical indicators for assessing the severity of COPD,and health status is the most strongly associated with morning symptoms.Clinical evaluation of morning symptoms in patients with COPD can be helpful in comprehensive assessment of the patient’s condition.