CAT、mMRC评分在评估COPD患者分组中的差异性研究  

A study of differences in classification of COPD patients with CAT or mMRC

作　　者：杨建民[1] 郑喜文[1] 陈雪[1] 姚淑芳[1] 吴生灵[1] 陶秀林[1] 黄慕超 

机构地区：[1]广东药学院附属第二医院广州新海医院呼吸内科,广东广州510300

出　　处：《中华全科医学》2017年第7期1181-1184,共4页Chinese Journal of General Practice

基　　金：2015年广东省医学科研基金项目(A2015604)

摘　　要：目的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是全球最重要的病种之一,2011年新版GOLD指南采用新的方法对COPD患者进行分组,本研究的目的是对比分析CAT、m MRC评分系统在COPD患者分组评估中的差异性,同时对各组进行活动耐力检测及分析。方法选择2015年7月—2016年7月广州新海医院呼吸内科门诊就诊的COPD稳定期患者160例,根据2011年GOLD指南分别使用CAT临床症状问卷评分、m MRC呼吸困难问卷评分、肺功能严重程度分级以及每年急性加重次数进行分组(A、B、C、D组),进行不同分组的比较,同时所有患者均参与活动耐力测试,使用计步器电子设备记录每天步行数量。采用Kappa检验、单因素方差分析、秩和检验或χ2检验。结果使用CAT评分分组中,有105例(61.25%)在多症状组(B或D),而用m MRC评分分组中,有61例(41.25%)在多症状组(B或D);采用肺功能分级进行危险分组,有70例(43.75%)在高风险组(C或D),用每年急性加重次数分组有76例(47.50%)患者在高风险组(C或D)。CAT组和m MRC组显示出显著相关性(r=0.45,P<0.001),同时肺功能严重程度与急性加重亦显示一样的相关性(r=0.31,P<0.001)。无论哪种分组方式,与A组相比较,B组与C+D组的日常步行是下降的。结论使用CAT临床症状问卷评分、m MRC呼吸困难问卷评分、1年内急性加重次数、肺功能下降严重程度为COPD患者进行A^D的危险分组时,分组结果有一定的差异性。日常步行数随着COPD患者危险分组的增加而下降。Objective Chronic obstructive pulmonary disease （COPD） is one of the most important diseases in the world. In the 2011 new version of the GOLD Guide, a new system was used to classify COPD patients. The aim of study was to investigate the agreement between COPD risk group classifications using COPD assessment（CAT） or modified Medical Research Council（mMRC） and severity grades or past-year exacerbations. Physical activity across was examined and analyzed. Methods One hundred and sixty patients with stable COPD were classified into risk group A -D. CAT and mMRC were completed. Severity grades Ⅰ - Ⅳ were determined using spirometry and the number of past-year exacerbations was recorded. To test the interrater agreement, Cohen ＇ s Kappa was calculated. Daily physical activity was measured by Mini arm band. Results Using CAT,105 patients were in high-symptom groups（B and D）. With mMRC,61 patients （41.25%） were in groups B and D. Using severity grades Ⅰ -Ⅳ ,70（43.75% ） of patients were in high-exacerbation risk groups C and D. With past-year exacerbations ,76（47.5% ） patients were in C and D. Interrater agreement between CAT and mMRC was fair（ r = 0.45 ,P 〈 0. 001 ）, severity grades and past year-year exacerbation was also fair. Daily steps were reduced in risk groups B and C ＋ D compared to A（ P 〈 0.1 ）, using either classification. Conclusion When classifying COPD patients into risk groups A - D ,the use of CAT or mMRC and severity grades or past-year exacerbations can＇ t provide equal results. Daily steps decreased with increasing COPD risk groups.

关 键 词：慢性阻塞性肺疾病 CAT评分 mMRC评分 步行数量 GOLD指南分级 

分 类 号：R563[医药卫生—呼吸系统]