713例慢性阻塞性肺疾病若干问题的回顾性研究

Retrospective studies on 713 cases chronic obstructive pulmonary disease

目的 探讨慢性阻塞性肺疾病 (COPD)诊断分级标准、早期干预及“吸烟危害健康”卫生教育的成效等若干问题。方法 对过去 10年有肺功能测定记录的 713例缓解期COPD患者进行回顾性研究 ,将肺功能受损程度按相关标准进行分级 ,与COPD防治全球倡议 (GOLD)标准进行比较 ,并就吸烟史、吸烟量、戒烟率等进行统计分析。结果 按中华呼吸学会 1997年制定的COPD诊断分级标准和传统肺功能不全分级标准 ,重度COPD共 339例 ,占样本总数的 5 6 .0 % ,中度 2 0 0例占2 8.0 % ,轻度 114例占 16 .0 % ,其中轻度组的FEV1 FVC比值为 70 .5 %± 1.1% ,高于GOLD <70 %的标准 ;吸烟患者共 335例 ,占总样本的 4 6 .9% ,其中男性 312例 ,占吸烟总例数的 93% ,女性 2 3例占7% ,吸烟史平均 32 .9年 ,日吸烟量平均 2 2支 ,已戒烟 2 16例 ,占吸烟例数的 6 4 .5 %。结论 GOLD和中华呼吸学会 2 0 0 2年修订的COPD诊断分级标准将FEV1 FVC作为COPD诊断分级的决定性先决条件值得商榷 ,其有可能将相当一部分早期的COPD患者漏诊 ;轻度COPD患者到医院就诊率仅15 .9% ,表明早期干预比率太低 ,对COPD的防治极为不利 ;COPD患者戒烟率为 6 4 .5 % ,虽然远比受综合干预的普通人群的 2 8%为高 ,但远远未如人意 。

Objective To study the diagnostic criteria of severity of chronic obstructive pulmonary diseases (COPD), early intervention, and the effect of health education on the velationship between smoking and health. Methods Data from 713 remissive COPD patients who had results of pulmonary function test in the past 10 years were reviewed. All patients were classified by correlative diagnostic criteria, and the results were compared with the diagnostic criteria of WHO Global Initiative for chronic obstructive lung disease(GOLD). Other indexes such as history of smoking, quantity of smoking and the rate of giving up smoking were also analyzed. Results According to the diagnostic criteria set by the Chinese Respiratory College in 1997 and traditional pulmonary function criteria, 339 patients were identified as having severe COPD, taking up 56.0 % of all COPD patients; 200 patients were moderate ( 28.0 %); 114 patients were mild ( 16.0 %). FEV 1/FVC in mild COPD patients was 70.5%± 1.1 %, higher than the criteria of 70% in GOLD. Three hundred and thirty-five patients were smokers, taking up 46.9 % of total patients. In these patients, 312 patients were men (93%) and 23 patients were women (7%). The average smoking history was 32.9 years, and the average quantity of daily smoking was 22. Two hundred sixteen patients had given up smoking which took up 64.5 % of all the smokers. Conclusions It was debatable that FEV 1/FVC was decisive criteria for COPD diagnoses by GOLD and the revised diagnostic criteria of Chinese Respiratory College in 2002. It might miss diagnosing a number of COPD patients who having combined ventilatory disturbance or were in earlier stages. Only 15.9 % of mild COPD patients had seen a doctor, that indicated a very low rate of early intervention which was disadvantageous for the prevention and cure of COPD.In contrast to the rate of 28.0 % when giving up smoking in ordinary people who had received general intervention, the rate of giving up smoking in COPD patients remained 64.5 % much higher and was dissatisfactory. Health education should be improved to include measures to give up smoking.