我国老年哮喘患者的临床特征及自我管理和认知水平的调查分析  

An epidemiological survey on clinical features,self-management and cognitive level of elderly asthmatics in China

作　　者：王文雅[1] 林江涛[1] 周新[2] 陈萍 万欢英[4] 殷凯生 马利军[6] 吴昌归 李靖[8] 刘春涛[9] 谢华 汤葳 黄茂 陈燕[8] 刘媛华[9] 宋立强 陈献亮[6] 刘国梁[1] 张永明[1] 李雯[1] 孙力超[1] Wang Wenya;Lin Jiangtao;Zhou Xin;Chen Ping;Wan Huanying;Yin Kaisheng;Ma Lijun;Wu Changgui;Li Jing;Liu Chuntao;Xie Hua;Tang Wei;Huang Mao;Chen Yan;Liu Yuanhua;Song Liqiang;Chen Xianliang;Liu Guoliang;Zhang Yongming;Li Wen;Sun Lichao(Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Respiratory Diseases,Shanghai General Hospital of Shanghai Jiaotong University,Shanghai 201315,China;Department of Pulmonary and Critical Care Medicine,General Hospital of Northen Theater Shenyang Command,Shenyang 110016,China;Department of Pulmonary and Critical CareMedicine,Ruijin Hospital of Shanghai Jiaotong University,Shanghai 200025,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Pulmonary and Critical Care Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Pulmonary and Critical Care Medicine,Chest Hospital of Xi′an International Medical Center,Xi′an 710100,China;Guangzhou Institute of Respiratory Disease,Department of Respiratory Diseases,First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Respiratory Diseases West China Hospital of Sichuan University,Chengdu 610041,China;Department of Pulmonary and Critical Care Medicine,Xijing Hospital of Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]中日友好医院呼吸与危重症医学科,北京100029 [2]上海交通大学第一人民医院呼吸科,上海201315 [3]北部战区总医院呼吸与危重症医学科,沈阳110016 [4]上海交通大学附属瑞金医院呼吸与危重症医学科,上海200025 [5]南京医科大学第一附属医院呼吸与危重症医学科,南京210029 [6]河南省人民医院呼吸与危重症医学科,郑州450003 [7]西安国际医学中心胸科医院呼吸与危重症医学科,西安710100 [8]广州呼吸疾病研究所广州医科大学附属第一医院呼吸内科,广东510120 [9]四川大学华西医院呼吸与危重症医学科,成都610041 [10]空军军医大学西京医院呼吸与危重症医学科,西安710032

出　　处：《中华医学杂志》2020年第18期1426-1431,共6页National Medical Journal of China

基　　金：首都卫生发展科研专项重点攻关项目(2016-1-4061)。

摘　　要：目的调查分析我国老年哮喘患者的临床特征及自我管理和认知水平。方法于2010年2月至2012年8月,在我国华北地区的北京市、东北地区的辽宁省、华东地区的上海市和江苏省、华中地区的河南省、华南地区的广东省、西南地区的四川省和西北地区的陕西省共7个大区8个省市,按照多阶整群随机抽样方法对164215例受访者进行问卷调查。其中确诊2034例哮喘患者,对其中符合老年哮喘入选标准的哮喘患者进一步分析,了解我国老年哮喘患者常见临床表现、合并症、哮喘控制和对疾病自我管理和认知情况。结果2034例哮喘患者中,年龄≥65岁老年哮喘组共584例(28.7%),非老年哮喘组1450例(71.3%)。老年哮喘组中早发型439例(75.2%),晚发型145例(24.8%);常见临床表现为:胸闷395例(67.6%)、喘息304例(52.1%)、咳嗽298例(51.0%);常见合并症为:慢性阻塞性肺疾病144例(24.7%)、过敏性鼻炎122例(20.9%)、胃食管反流病114例(19.5%)、过敏性眼结膜炎86例(14.7%)、湿疹82例(14.0%)、慢性支气管炎76例(13.0%);老年哮喘组哮喘控制测试(ACT)评分显著低于非老年哮喘组[(18.5±3.2)比(21.7±3.4)分](P=0.042)。老年哮喘组仅13例(2.2%)每日使用峰流速仪进行病情监测,仅93例(15.9%)和64例(11.0%)患者能正确认识哮喘的本质和治疗目标。结论我国老年哮喘患者临床症状常不典型,典型发作性喘息少见,且合并症多,哮喘控制水平较差,患者对哮喘疾病的自我管理和认知水平有待提高。Objective To investigate the prevalence of asthma among the elderly people in China and to analyze the clinical features,self-management and cognitive level of elderly asthma patients.Methods According to the multi-stage random cluster sampling methods,a total of 164215 subjects were visited by a questionnaire in the last epidemiology survey from eight provinces(Beijing,Shanghai,Guangdong,Liaoning,Henan,Shanxi,Jiangsu,Sichuan provinces)and seven regions(north,northeast,southern china,east,south,southwest and northwest)in China from February 2010 to August 2012.2034 were diagnosed as asthma.The elderly patients aged≥65 years were selected from the 2034 asthma patients.The clinical characteristics,comorbidities,the status of asthma control and self-management and insights of the disease in elderly asthma patients were analyzed.Results Among the 2034 asthma patients,584(28.7%)were elderly asthmatics aged≥65 years old and 1450(71.3%)were<65 years old.In the elderly asthma group,Early-onset asthma accounted for 439(75.2%)and 145(24.8%)were late-onset.The common clinical manifestations of elderly asthma patients were:chest distress 395(67.6%),wheezing 304(52.1%),cough 298(51.0%).Common comorbidities of elderly asthmatics were:chronic obstructive pulmonary disease 144(24.7%),allergic rhinitis 122(20.9%),gastroesopheal reflux disease(GERD)114(19.5%),allergic conjunctivitis 86(14.7%),eczema 82(14.0%),chronic bronchitis 76(13.0%).The Asthma Control Test(ACT)scores of elderly asthmatics and non-elderly asthmatics were(18.5±3.2)and(21.7±3.4)respectively.There was a significant difference between the two groups(P=0.042).Of the elderly asthmatics,only 13(2.2%)patients monitored daily using a peak flow meter.93(15.9%)patients aware that asthma was characterized by chronic airway inflammation.64(11.0%)asthmatics understood that the treatment goal.Conclusions The clinical manifestations of elderly asthmatics are atypical,especially paroxysmal wheezing.Asthma in elderly people causes more comorbidities and mortality.The self

关 键 词：哮喘 老年人 疾病特征 疾病管理 流行病学 

分 类 号：R5[医药卫生—内科学]