2018—2021不同年度慢性阻塞性肺疾病患者的临床特征及治疗情况

The clinical characteristics and treatment of patients with chronic obstructive pulmonary disease from year of 2018 to 2021

目的 比较2018、2019、2020及2021年度就诊的慢性阻塞性肺疾病(简称慢阻肺)患者的临床特征以及治疗方案的差异。方法 采用多中心横断面研究,纳入2018年1月1日—2021年12月31日在我国南方地区13家医院呼吸与危重症医学科首次就诊的稳定期慢阻肺患者,根据患者初次就诊的时间分为2018年度组、2019年度组、2020年度组及2021年度组。收集患者的基本资料、肺功能、慢阻肺评估测试问卷(COPD assessment test,CAT)、过去1年急性加重次数及治疗方案等。结果 2018、2019、2020及2021年度患者的CAT评分为(16.5±6.7)分、(14.5±6.7)分、(14.1±6.2)分及(13.4±6.6)分,CAT评分逐年降低(P<0.05)。2018、2019、2020及2021年度患者的第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second in percent predicted value,FEV_(1)%pred)分别为(52.8±21.4)%、(51.3±19.2)%、(53.4±21.5)%及(56.6±21.7)%,与2018、2019及2020年度患者相比,2021年度患者的FEV_(1)%pred更高(P<0.05)。2018、2019、2020及2021年度患者过去1年急性加重次数的中位数分别为1、1、0及0次,与2018及2019年度患者相比,2020及2021年度患者过去1年急性加重次数中位数更低(P<0.05)。2018、2019、2020及2021年度使用双支扩[长效β2受体激动剂(long-actingβ2-agonist,LABA)+长效抗胆碱药(long-acting muscarinic antagonist,LAMA)]和三联[LAMA+LABA+吸入性糖皮质激素(inhaled corticosteroid,ICS)]吸入药物患者的比例分别为0%、0.7%、3.5%和17.0%,以及47.9%、41.2%、27.8%和26.0%。与2018及2019年度患者相比,2020及2021年度患者双支扩使用比例更高,而三联吸入药物比例更低(P<0.05)。2018、2019、2020及2021年度接种流感/肺炎疫苗患者比例为0%、0.1%、3.5%及4.3%。与2018及2019年度患者相比,2020及2021年度接种流感/肺炎疫苗患者比例更高(P<0.05)。结论 近年来我国慢阻肺患者就诊时症状减轻、急性加重次数减少,就诊时间有前移趋势,双支扩药物(LABA+LAMA)使用增加,三联吸入药物(LAMA+LABA+ICS)使用有所减少,流感/肺炎疫苗接种患者比例有所增加,但总体接种率仍较低。

Objective To compare the clinical characteristics and treatment of patients with chronic obstructive pulmonary disease(COPD) in the year of 2018,2019,2020,and 2021.Methods A cross-sectional multicenter study was conducted on patients with stable COPD from 13 hospitals of China south area in year of 2018,2019,2020 and 2021.The demographic data,pulmonary function,COPD assessment test(CAT),exacerbation in the past year and treatment regimens were collected.Results The CAT scores of the COPD patients in the year of 2018,2019,2020 and 2021 were(16.5±6.7),(14.5±6.7),(14.1±6.2) and(13.4±6.6),respectively.The CAT scores decreased year by year(P<0.05).The forced expiratory volume in one second percentage predicted value(FEV1%pred) of the COPD patients in the year of2018,2019,2020 and 2021 were(52.8±21.4)%,(51.3±19.2)%,(53.4±21.5)% and(56.6±21.7)%,respectively.Compared with year of 2018,the patients in 2019,2020 and 2021 had higher FEV_1%pred.Compared with year of 2019 and 2020,the patients 2021 had higher FEV_1%pred(P<0.05).The median of exacerbation in the past year of the COPD patients in the year of 2018,2019,2020 and 2021 were 1,1,0 and 0,respectively.Compared with year of 2018 and 2019,the median of exacerbation in the past year in 2020 and 2021 were lower(P<0.05).The proportion of double [long-acting β2-agonist(LABA)+long-acting muscarinic antagonist(LAMA)] and triple inhaled [LAMA+LABA+ inhaled corticosteroid(ICS)]drugs were 0%,0.7%,3.5% and 17.0%,as well as 47.9%,41.2%,27.8% and 26.0%.Compared with year of 2018 and 2019,the proportion of double inhaled drugs in 2020 and 2021 was higher,while triple inhaled drugs was lower(P<0.05).In addition,the proportion of influenza vaccine/pneumonia vaccine was 0%,0.1%,3.5% and 4.3%,respectively.Compared with year of 2018 and 2019,the proportion of influenza vaccine/pneumonia vaccine in year of 2020 and 2021 was higher(P<0.05).Conclusions Symptoms and exacerbation burden of patients with COPD tend to be less in China in recent years and the time of patients visited hospital tends to move forward.Furthermore,the proportion of patients with double inhaled drugs(LABA+LAMA) increased,while triple inhaled(LAMA+LABA+ICS) decreased.In addition,the proportion of patients vaccinated with influenza/pneumonia is increased but the overall proportion is still low.