慢性阻塞性肺疾病评估测试对COPD急性加重的有效性评估  

The clinical validity of the chronic obstructive pulmonary disease assessment test in COPD exacerbations

作　　者：柴晶晶[1] 朱华栋[1] 于学忠[1] 柳涛[2] 蔡柏蔷[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院呼吸内科

出　　处：《中国急救医学》2017年第2期158-163,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的慢性阻塞性肺疾病（chronicobstructivepulmonarydisease，COPD）评估测试（CAT）是一种简单、有效、可靠的工具，评估COPD患者健康相关生活质量（health-relatedqualityoflife，HRQL）。本研究旨在探讨CAT对COPD急性加重的临床应用价值，评估其在COPD患者生活质量的有效性、敏感度。方法选择北京协和医院门急诊就诊或住院并自愿参加的稳定期COPD的患者，采用CAT中文版及SGRQ中文版对患者的生活质量进行评分，问卷均由患者本人独立完成，在问卷调查当天进行肺功能测试，包括常规通气功能测定（FEVl、FVC和PEF）及支气管舒张试验，在6个月随访患者，完成CAT及SGRQ问卷及患者COPD急性加重情况。应用SPSS15．0统计学软件对结果进行统计分析。结果稳定期COPD患者192例，男146例，女46例，年龄45～84岁，平均（64．3±9．4）岁；吸烟指数为10～90包／年，平均（35．5±21．1）包／年；肺功能FEV1（1．2±0．5）L，FEV1％（45．1±17．7）％，FEV1／FVC（48．4±12．4）％；CAT量表（15．5±6．9）分。其中74例患者完成SGRQ量表，症状评分（58．0±20．9）分，活动评分（58．4±16．1）分，影响评分（39．4±18．2）分，总评分（48．2±15．5）分。根据GOLD指南分级分为Ⅰ、Ⅱ、Ⅲ及Ⅳ级，不同分级CAT评分分别是（9．4±3．6）分、（13．3±5．3）分、（17．2±6．0）分及（21．7±7．0）分。CAT量表与SGRQ评分呈显著正相关，与肺功能FEV1％、FEV1／FVC呈显著负相关（r=-0．48和-0．36，P〈0．01）。对192例COPD患者进行6个月随访，其中153例（79．7％）患者出现1次或更多急性加重，对急性加重危险因素进行Logistic回归分析显示，女性、高龄、肺功能降低，高GOLD分级、SGRQ评分增高和CAT评分增高是COPD急性加重的危险因素。192例COPD患者中，无急性加重39例，发生1次急性加重122例，发生2次及2次以上急性�Objective The chronic obstructive pulmonary disease （COPD） assessment test （CAT） is proposed for assessing health - related quality of life for COPD patients. The objective of this study is to evaluate the validity of the CAT in Chinese patients with COPD. Methods Stable COPD patients who were willing to fill out the CAT and St George＇s Respiratory Questionnaire （SGRQ） wereenrolled in this study, and pulmonary function tests were performed on the same day. During the six - month follow - up period, the frequency of exacerbations was collected and analyzed to determine the risk factors associated with the exacerbations. Results A total of 192 Chinese COPD patients were enrolled in this study. All of patients completed the 6 - month follow - up period, and 74 patients completed the SGRQ. Forced expiratory volume in 1 s （FEV1） and FEVI% predicted were （1.2 ±0. 5）L and （45.1±17. 7）%; the total CAT and SGRQ score were （15. 5 ±6. 9） and （48. 2 ± 15. 5）, respectively. The CAT was strongly positively correlated with the SGRQ. Female gender, age, reduced pulmonary function, high Global Initiative for Chronic Obstructive Lung Disease （GOLD） stage, high SGRQ score and high CAT score are risk factors for acute exacerbation of COPD. A higher score indicates an increased likelihood of experiencing exacerbations. Conclusion The CAT provides a valid, reliable and standardised measurement to assess the health - related quality of life for Chinese COPD patients and is a good tool for predicting disease severity and is one of the risk factors of COPD exacerbation.

关 键 词：慢性阻塞性肺疾病(COPD) 急性加重 健康状态 生活质量 问卷调查 

分 类 号：R563[医药卫生—呼吸系统]