不同评分系统在慢性阻塞性肺疾病病情评估中的应用价值分析
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摘要
目的分析圣乔治呼吸问卷(SGRQ)、慢性阻塞性肺疾病临床呼吸问卷(CCQ)、改良英国医学研究理事会呼吸困难指数(m MRC)、慢性阻塞性肺疾病(COPD)评估测试量表(CAT)在COPD病情评估中的应用价值。方法采用回顾性研究的方法,将2016年12月至2018年1月在海军特色医学中心老年医学科及解放军第四五一医院老年医学科确诊的100例COPD患者纳入研究;所有患者均进行SGRQ、CCQ、m MRC、CAT评估,并按照COPD全球倡议(GOLD)2013版COPD分级标准将其分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级;检测肺功能指标第一秒用力呼气容积占预计值百分比(FEV1%pred)和血清降钙素原(PCT)。对比不同GOLG分级下FEV1%pred、血清PCT水平及SGRQ、CCQ、m MRC、CAT分值;将COPD患者分为不同病情严重程度,对比各个严重程度下SGRQ、CCQ、m MRC分值;对比m MRC不同评分下SGRQ、CCQ、CAT分值。采用Pearson相关性分析研究SGRQ、CCQ、m MRC、CAT分值与FEV1%pred、PCT的关系,分析4个评分系统间的关系。结果 GOLDⅠ、Ⅱ、Ⅲ、Ⅳ级血清PCT水平、FEV1%pred及SGRQ总分、CCQ分值、m MRC分值、CAT分值比较,差异均具有统计学意义(P <0. 05); SGRQ、CCQ、m MRC、CAT分值均与FEV1%pred呈负相关(r=-0. 842、-0. 571、-0. 718、-0. 434,P <0. 001),与PCT呈正相关(r=0. 418、0. 409、0. 610、0. 507,P <0. 001),与GOLD分级呈正相关(r=0. 760、0. 814、0. 000、0. 614,0. 609,P <0. 001); CAT评分下轻微至非常严重4个级别COPD患者SGRQ、CCQ、m MRC分值差异具有统计学意义(P <0. 05); m MRC 0分、1分、2分、3分患者SGRQ、CCQ、CAT分值差异均具有统计学意义(P <0. 05);Pearson相关性分析发现,4个评分系统间有显著相关性(P <0. 01)。结论 SGRQ、CCQ、m MRC、CAT评分工具与COPD肺功能指标、血清PCT、病情严重程度密切相关,4个评分系统间有良好相关性,可以用于COPD病情评估中。
Objective To analyze the signifcance of application of St George's respiratory questionnaire( SGRQ),clinical COPD questionnaire( CCQ),and modified British medical research council( m MRC) index.,COPD assessment test( CAT) in patients with chronic obstructive pulmonary disease( COPD). Methods Retrospective analysis method was used to include 100 COPD patients diagnosed during December 2016 to January 2018. All these patients were evaluated by SGRQ,CCQ,m MRC,CAT according to COPD worldwide evaluation. The global initiative for chronic obstructive lung disease( GOLD) 2013 version of the COPD grading standard classifies it into grades I,II,III,and IV; the percentage of predicted expiratory volume in the first second of lung function index( FEV1% pred) and serum level of procalcitonin( PCT). The FEV1% pred,serum PCT level,and SGRQ,CCQ,m MRC,and CAT scores were compared for different GOLG grades; COPD was divided into different disease levels of severity by CAT; SGRQ,CCQ,and m MRC scores for each grade of severity were compared; Scores SGRQ,CCQ,CAT scores. Pearson correlation was used to analyze the relationship between SGRQ,CCQ,m MRC,CAT scores and FEV1% pred,PCT,and the relationship between these four scoring systems was analyzed. Results Serum PCT levels,FEV1% pred and SGRQ scores,CCQ scores,m MRC scores,and CAT scores were significantly different in GOLD I,II,III,and IV grades( P < 0. 05); SGRQ,CCQ,the m MRC scores of CAT and CAT were negatively correlated with FEV1% pred( r =-0. 842,-0. 571,-0. 718,-0. 434,P < 0. 001),and positively correlated with PCT( r = 0. 418,0. 409,0. 610,0. 507,P < 0. 001),positively correlated with GOLD classification( r = 0. 760,0. 814,0. 000,0. 614,0. 609,P < 0. 001). CAT scores were mild to very severe. There was statistically significant difference in SGRQ,CCQ,and m MRC scores forfour levels of COPD patients( P < 0. 05). SGRQ,CCQ,and CAT scores at 0,1,2,and 3 m MRC were significantly different( P < 0. 05).Pearson correlation analysis revealed a significant correlation between these four scoring systems( P < 0. 05). Conclusion The SGRQ,CCQ,m MRC and CAT scoring tools are closely related to the COPD index of lung function,serum PCT,severity of illness,and there is a good relationship between these four scoring systems and they can be used in the assessment of COPD conditions.
Objective To analyze the signifcance of application of St George's respiratory questionnaire( SGRQ),clinical COPD questionnaire( CCQ),and modified British medical research council( m MRC) index.,COPD assessment test( CAT) in patients with chronic obstructive pulmonary disease( COPD). Methods Retrospective analysis method was used to include 100 COPD patients diagnosed during December 2016 to January 2018. All these patients were evaluated by SGRQ,CCQ,m MRC,CAT according to COPD worldwide evaluation. The global initiative for chronic obstructive lung disease( GOLD) 2013 version of the COPD grading standard classifies it into grades I,II,III,and IV; the percentage of predicted expiratory volume in the first second of lung function index( FEV1% pred) and serum level of procalcitonin( PCT). The FEV1% pred,serum PCT level,and SGRQ,CCQ,m MRC,and CAT scores were compared for different GOLG grades; COPD was divided into different disease levels of severity by CAT; SGRQ,CCQ,and m MRC scores for each grade of severity were compared; Scores SGRQ,CCQ,CAT scores. Pearson correlation was used to analyze the relationship between SGRQ,CCQ,m MRC,CAT scores and FEV1% pred,PCT,and the relationship between these four scoring systems was analyzed. Results Serum PCT levels,FEV1% pred and SGRQ scores,CCQ scores,m MRC scores,and CAT scores were significantly different in GOLD I,II,III,and IV grades( P < 0. 05); SGRQ,CCQ,the m MRC scores of CAT and CAT were negatively correlated with FEV1% pred( r =-0. 842,-0. 571,-0. 718,-0. 434,P < 0. 001),and positively correlated with PCT( r = 0. 418,0. 409,0. 610,0. 507,P < 0. 001),positively correlated with GOLD classification( r = 0. 760,0. 814,0. 000,0. 614,0. 609,P < 0. 001). CAT scores were mild to very severe. There was statistically significant difference in SGRQ,CCQ,and m MRC scores forfour levels of COPD patients( P < 0. 05). SGRQ,CCQ,and CAT scores at 0,1,2,and 3 m MRC were significantly different( P < 0. 05).Pearson correlation analysis revealed a significant correlation between these four scoring systems( P < 0. 05). Conclusion The SGRQ,CCQ,m MRC and CAT scoring tools are closely related to the COPD index of lung function,serum PCT,severity of illness,and there is a good relationship between these four scoring systems and they can be used in the assessment of COPD conditions.
引文
[1]倪明德,文强,钱强,等.老年慢性阻塞性肺疾病合并肺结核感染的临床观察[J].中华医院感染学杂志,2015,20(7):1560-1561,1581.
[2]刘盛盛,张妍蓓.血清降钙素原水平对慢性阻塞性肺疾病急性加重期抗生素使用的指导价值[J].中国抗生素杂志,2015,40(6):459-463.
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[4]谢柏梅,敬梅,张彦海,等.慢性阻塞性肺疾病临床问卷对稳定期慢性阻塞性肺疾病生活质量的评价[J].解放军医药杂志,2017,29(4):41-44.
[5] Jansson SA,Backman H,R9nmark E,et al. Hospitalization Due to Co-Morbid Conditions is the Main Cost Driver Among Subjects With COPD-A Report From the Population-Based OLIN COPD Study[J].COPD,2015,12(4):381-389.
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[7]廖茜. TNF-α、s TREM-1、IL-6、PCT在慢性阻塞性肺疾病伴肺炎诊断中的应用[J].临床肺科杂志,2015,20(3):530-532,535.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[9]宣萱,李艳.降钙素原、超敏C反应蛋白、D-二聚体和纤维蛋白原在COPD急性加重期患者的动态变化及临床意义[J].临床和实验医学杂志,2015,14(3):202-204.
[10]张振柱,徐兴祥.慢性病管理对慢性阻塞性肺疾病患者的肺功能、SGRQ评分及急性加重次数的影响[J/CD].中华肺部疾病杂志(电子版),2017,10(5):525-529.
[11]陈东红,李方治,刘朔,等.老年中重度稳定期慢性阻塞性肺疾病患者应用噻托溴铵的疗效与安全性[J].中国老年学杂志,2015,35(17):4916-4918.
[12] Ito S,Araya J,Kurita Y,et al. PARK2-mediated mitophagy is involved in regulation of HBEC senescence in COPD pathogenesis[J]. Autophagy,2015,11(3):547-559.
[13]陈旭,杨晓芸,刘淑敏,等.老年慢性阻塞性肺疾病患者生活质量调查及干预对策[J].中国全科医学,2017,20(27):3431-3436.
[14]柴晶晶,朱华栋,于学忠,等.慢性阻塞性肺疾病评估测试对COPD急性加重的有效性评估[J].中国急救医学,2017,37(2):158-163.
[15] Casanova C,Marin JM,Martinez-Gonzalez C,et al. Differential Effect of Modified Medical Research Council Dyspnea,COPD Assessment Test,and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD[J]. Chest,2015,148(1):159-168.
[16]李盛,陈锋,李建斌,等.慢性阻塞性肺疾病患者医院感染临床特征与CAT评分的评估[J].中华医院感染学杂志,2016,26(9):1952-1954.
[17]姜轶飞,杨猛,莫伟强.慢性阻塞性肺疾病评估测试评分对AECOPD患者的临床评估价值[J].中国中西医结合急救杂志,2017,24(2):174-176,216.
[18]贾睿奕,张阳,苏艳娜,等. COPD稳定期患者肺功能与DOSE指数及CCQ的相关性研究[J].重庆医学,2016,45(4):462-464.
[19]董晓艳,王岚,索秀丽,等.慢性阻塞性肺疾病患者ADO指数与生活质量的相关性[J].广东医学,2017,38(22):3513-3517.
[2]刘盛盛,张妍蓓.血清降钙素原水平对慢性阻塞性肺疾病急性加重期抗生素使用的指导价值[J].中国抗生素杂志,2015,40(6):459-463.
[3] van der Molen T,Willemse BW,Schokker S,et al. Development,validity and responsiveness of the Clinical COPD Questionnaire[J]. Health Qual Life Outcomes,2003,1:13.
[4]谢柏梅,敬梅,张彦海,等.慢性阻塞性肺疾病临床问卷对稳定期慢性阻塞性肺疾病生活质量的评价[J].解放军医药杂志,2017,29(4):41-44.
[5] Jansson SA,Backman H,R9nmark E,et al. Hospitalization Due to Co-Morbid Conditions is the Main Cost Driver Among Subjects With COPD-A Report From the Population-Based OLIN COPD Study[J].COPD,2015,12(4):381-389.
[6]郭薇,刘启贵,张娜.慢性阻塞性肺疾病患者生活质量及其影响因素[J].中国老年学杂志,2015,35(6):1664-1667.
[7]廖茜. TNF-α、s TREM-1、IL-6、PCT在慢性阻塞性肺疾病伴肺炎诊断中的应用[J].临床肺科杂志,2015,20(3):530-532,535.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
[9]宣萱,李艳.降钙素原、超敏C反应蛋白、D-二聚体和纤维蛋白原在COPD急性加重期患者的动态变化及临床意义[J].临床和实验医学杂志,2015,14(3):202-204.
[10]张振柱,徐兴祥.慢性病管理对慢性阻塞性肺疾病患者的肺功能、SGRQ评分及急性加重次数的影响[J/CD].中华肺部疾病杂志(电子版),2017,10(5):525-529.
[11]陈东红,李方治,刘朔,等.老年中重度稳定期慢性阻塞性肺疾病患者应用噻托溴铵的疗效与安全性[J].中国老年学杂志,2015,35(17):4916-4918.
[12] Ito S,Araya J,Kurita Y,et al. PARK2-mediated mitophagy is involved in regulation of HBEC senescence in COPD pathogenesis[J]. Autophagy,2015,11(3):547-559.
[13]陈旭,杨晓芸,刘淑敏,等.老年慢性阻塞性肺疾病患者生活质量调查及干预对策[J].中国全科医学,2017,20(27):3431-3436.
[14]柴晶晶,朱华栋,于学忠,等.慢性阻塞性肺疾病评估测试对COPD急性加重的有效性评估[J].中国急救医学,2017,37(2):158-163.
[15] Casanova C,Marin JM,Martinez-Gonzalez C,et al. Differential Effect of Modified Medical Research Council Dyspnea,COPD Assessment Test,and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD[J]. Chest,2015,148(1):159-168.
[16]李盛,陈锋,李建斌,等.慢性阻塞性肺疾病患者医院感染临床特征与CAT评分的评估[J].中华医院感染学杂志,2016,26(9):1952-1954.
[17]姜轶飞,杨猛,莫伟强.慢性阻塞性肺疾病评估测试评分对AECOPD患者的临床评估价值[J].中国中西医结合急救杂志,2017,24(2):174-176,216.
[18]贾睿奕,张阳,苏艳娜,等. COPD稳定期患者肺功能与DOSE指数及CCQ的相关性研究[J].重庆医学,2016,45(4):462-464.
[19]董晓艳,王岚,索秀丽,等.慢性阻塞性肺疾病患者ADO指数与生活质量的相关性[J].广东医学,2017,38(22):3513-3517.