GOLD综合评估指标在高原慢阻肺患者中的应用探讨

Application of GOLD comprehensive assessment indexes in patients with chronic obstructive pulmonary disease at high altitude

目的评价慢性阻塞性肺疾病全球倡议(GOLD)综合评估指标在高原慢性阻塞性肺疾病(简称慢阻肺)评估中的应用价值。方法2016年3月至2017年11月青海大学附属医院呼吸内科确诊为慢阻肺的患者175例,分析其病情特点、GOLD综合评估指标间的相关性,分析GOLD 2016和GOLD 2017两种综合评估法在入选患者分组中的差异。结果1.肺功能分级GOLD1级慢阻肺患者呼吸衰竭有14例(45.2%),肺动脉高压有3例(9.7%),6分钟步行距离(6MWD)下降有15例(48.4%),血红蛋白增多有7例(22.6%)。2.GOLD1级至3级CAT评分与FEV 1%pred无显著相关性(均P>0.05)。3.GOLD 2016评估法中有39例D组的患者分到GOLD 2017评估法中的B组;GOLD 2017推荐使用吸入激素的患者比例(54例,36.5%)显著低于GOLD 2016(94例,63.5%)(P<0.05)。结论1.高原慢阻肺患者呼吸衰竭、肺动脉高压、血红蛋白增多及6MWD下降出现的早且重;2.高原慢阻肺患者中CAT评分与FEV 1%pred相关性较弱;3.GOLD 2017综合评估法可能低估高原慢阻肺患者病情,导致治疗的不充分。

Objective To evaluate the value of comprehensive evaluation indexes of the Global Initiative for Chronic Obstructive Lung Disease(GOLD)in patients with COPD at high altitude.Methods 175 patients with COPD who were admitted in the respiratory department of Qinghai University Affiliated Hospital from March 2016 to November 2017 were selected to analyze the conditions of patients,the relationship of the GOLD comprehensive evaluation indexes and the difference of two evaluation methods(the GOLD 2016 and the GOLD 2017).Results 1.There were 14(45.2%)patients with respiratory failure,3(9.7%)with pulmonary hypertension,15(48.4%)with 6-minute walking distance decreased(6MWD),and 7(22.6%)with hemoglobin increased in GOLD 1.2.There was no significant correlation between CAT scores and FEV 1%pred in GOLD 1 to 3(all P>0.05).3.39 patients were assigned in the group D with GOLD 2016 but in the group B with GOLD 2017 method,and the proportion of patients recommended to use inhaled corticosteroid with GOLD 2017 method was lower than that with GOLD 2016 method.Conclusion 1.The patients with COPD at high altitude are more likely complicated with respiratory failure,pulmonary hypertension,increased hemoglobin and 6MWD early and heavy.2.The correlation between CAT scores and FEV 1%pred are less relevant in patients with COPD at high altitude.3.The comprehensive assessment in GOLD 2017 may underestimate the patients with COPD at high altitude and degrade the treatment.