慢性阻塞性肺疾病临床研究对象的确认:基于表象还是基于本质  

Identification of study populations in the clinical study of chronic obstructive pulmonary disease: Surface-based or essence-based

作　　者：冯云爱 李海潮[1] Feng Yun′ai;Li Haichao(Department of Respiratory and Critical Care Medicine,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院呼吸与危重症医学科,北京100034

出　　处：《中华结核和呼吸杂志》2023年第5期525-529,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：慢性阻塞性肺疾病(简称慢阻肺)是一种异质性疾病,其本质为慢性支气管炎、肺气肿或两者并存。慢阻肺全球倡议(GOLD)对慢阻肺的诊疗和研究产生了巨大的影响。本文通过回顾GOLD中慢阻肺定义的演变及其治疗策略改变的情况,结合相关临床研究试图说明认识慢阻肺异质性本质的重要意义,并分析对其本质忽略可能造成的影响,包括以肺功能为"金标准"所致的与支气管哮喘的混淆、吸入糖皮质激素(ICS)过度使用等。建议在临床实践中,应通过多种信息的搜集尽量明确慢阻肺患者的本质特征,并对其病情评价、治疗策略和康复采取相应的个性化处理。同时,应更多地开展基于疾病本质的慢阻肺基础与临床研究,探索治疗新方法。Chronic obstructive pulmonary disease(COPD)is a heterogeneous disorder characterized by chronic bronchitis,emphysema,or both.The Global Initiative for Chronic Obstructive Lung Disease(GOLD)has had a tremendous impact on the diagnosis and treatment of COPD.This article reviewed the evolution of the definition of COPD in GOLD and the change of its treatment strategy.In addition,in light of relevant clinical studies,the paper attempted to illustrate the importance of understanding the heterogeneous nature of COPD,and analyzed the possible consequences of ignoring this nature,including confusion with bronchial asthma caused by lung function as the"gold standard"and excessive use of inhaled glucocorticoids(ICS).It is suggested that in clinical practice,the essential characteristics of COPD patients should be clarified by collecting a variety of information in order to provide personalized treatment for patients′assessment,therapy and rehabilitation.At the same time,more basic and clinical research on COPD should be conducted,based on the nature of the disease,to explore new treatment methods.

关 键 词：疾病本质 异质性疾病 慢性阻塞性肺疾病 慢阻肺 治疗策略 慢性支气管炎 支气管哮喘 吸入糖皮质激素 

分 类 号：R563.9[医药卫生—呼吸系统]