规范性健康管理对社区轻度COPD患者痰细胞学指标、肺功能的影响及经济学评价  

Effect of Standardized Health Management on Sputum Cytology and Lung Function in Patients with Mild Chronic Obstructive Pulmonary Disease in Community and Its Economic Evaluation

作　　者：李淑芳 万敏敏 李红娜 LI Shufang;WAN Minmin;LI Hongna(Department of Respiratory Medicine,Binzhou People′s Hospital Affiliated to Shandong First Medical University,Binzhou 256600,China)

机构地区：[1]山东第一医科大学附属滨州市人民医院呼吸内科,山东滨州256600

出　　处：《医学综述》2022年第23期4760-4764,共5页Medical Recapitulate

基　　金：山东省医药卫生科技发展计划项目(2015WS0513)。

摘　　要：目的分析规范性健康管理对社区轻度慢性阻塞性肺疾病(COPD)患者痰细胞学指标、肺功能的影响及经济学评价。方法选取2019年3—9月山东第一医科大学附属滨州市人民医院收治的100例社区轻度COPD患者作为研究对象,依据干预方法不同分为对照组和试验组,每组50例。对照组仅予以常规治疗及社区常规性随访管理,根据自身情况自行决定就诊时机、用药情况等;试验组在对照组基础上予以规范性健康管理,遵医嘱用药、戒烟、肺功能锻炼等。随访24个月,比较两组患者治疗前及末次随访时的痰细胞学指标(巨噬细胞、中性粒细胞),不同时点间肺功能指标[第一秒用力呼气量(FEV_(1))、用力肺活量(FVC)、肺总量],以及末次随访时的成本-效果。结果巨噬细胞和中性粒细胞百分比时点间的主效应差异有统计学意义(P<0.01),组间的主效应差异无统计学意义(P>0.05),组间和时点间不存在交互作用(P>0.05);末次随访时,两组患者巨噬细胞百分比较治疗前升高、中性粒细胞百分比较治疗前下降(P<0.05)。FEV_(1)、FVC、肺总量时点间、组间的主效应差异有统计学意义(P<0.01),FEV_(1)、FVC的组间和时点间不存在交互作用(P>0.05),肺总量存在交互作用(P<0.01);治疗后6、12、18个月及末次随访时,两组FEV_(1)、FVC、肺总量呈上升趋势(P<0.05),试验组治疗后6、12、18个月及末次随访时各项指标均高于对照组(P<0.05)。末次随访时,试验组患者成本、成本-效果比低于对照组[(7216±2369)元比(10168±3365)元、546±129比1246±212](P<0.01),效果高于对照组[(15.92±3.62)%比(9.46±2.58)%](P<0.01)。结论规范性健康管理可明显改善社区轻度COPD患者痰细胞学指标及肺功能,且成本-效果更好。Objective To analyze the effect of standardized health management on sputum cytology indexes and pulmonary function of patients with mild chronic obstructive pulmonary disease(COPD)in the community,and make the economic evaluation.Methods A total of 100 community-based mild COPD patients admitted to Binzhou People′s Hospital Affiliated to Shandong First Medical University from Mar.to Sep.2019 were included.According to the different intervention methods,they were divided into a control group and a test group,with 50 cases in each group.The control group was only given routine treatment and routine follow-up management in the community,the patients of which decided to see a doctor or adopt medication according to their own conditions and decisions;the test group was given standardized health management to use medication,quit smoking and perform lung function exercise following the doctor′s advice.The patients were followed up for 24 months,and the sputum cytology indexes(macrophages,neutrophils),pulmonary function indexes[forced expiratory volume in first second(FEV_(1)),forced vital capacity(FVC),total lung capacity]before treatment and at the last follow-up of the two groups were compared,as well as the cost-effectiveness at last follow-up.Results The main effect differences of macrophages and neutrophils proportions between time points were statistically significant(P<0.01),but the main effect differences between groups were not statistically significant(P>0.05),and there was no interaction between groups and time points(P>0.05);at the last follow-up,the percentage of macrophages increased and percentage of neutrophils decreased in the two groups compared with those before treatment(P<0.05).There were statistically significant differences in the main effect of FEV_(1),FVC,and total lung capacity between time points and groups(P<0.01),and there were no interactions in FEV_(1),FVC between groups and time points(P>0.05),while there was interaction in total lung capacity(P<0.01).From 6,12,18 months after treatm

关 键 词：慢性阻塞性肺疾病 规范性健康管理 巨噬细胞 中性粒细胞 肺功能 经济学评价 

分 类 号：R563[医药卫生—呼吸系统]