南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (7): 1119-1124.doi: 10.12122/j.issn.1673-4254.2021.07.23

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不同评价系统对慢阻肺患者病情及治疗疗效的评估价值

谭漫琳，简文星，梁秋菊，李树钧，崔海燕   

  • 出版日期:2021-07-20 发布日期:2021-07-19

Comparison of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease

  • Online:2021-07-20 Published:2021-07-19

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摘要： 目的 探索不同评价系统对慢性阻塞性肺疾病（慢阻肺）患者临床诊疗的实用性和临床意义。方法 回顾性分析2020年11月~2021年1月收治入南方医科大学第三附属医院呼吸与危重症医学科的28例慢阻肺急性加重患者临床资料，收集患者入院时第1秒用力呼气容积占预计值百分比（FEV1%pred）、慢阻肺评估测试（CAT）、呼吸困难评分（mMRC）、基础呼吸困难指数（BDI）、慢阻肺临床问卷（CCQ）、圣乔治呼吸问卷（SGRQ）、BODE指数、汉密尔顿抑郁量表（HDRS）及出院1月后CAT、mMRC、呼吸困难变化指数（TDI）、CCQ、SGRQ、HDRS。对入院时的FEV1% pred、CAT、mMRC、BDI、CCQ、SGRQ、BODE、HDRS进行相关性分析，并根据患者出院后吸入药物种类，将患者分为单药组（8例）、二联组（10例）、三联组（10例），对3组患者出院1月后TDI及CAT、mMRC、CCQ、SGRQ、HDRS变化情况进行分析。结果 FEV1%pred与SGRQ、BDI中度相关(r=-0.66, r=0.61, P< 0.01)；CCQ活动评分与mMRC、SGRQ活动评分、BDI高度相关(r=0.82, r=0.92, r=-0.89, P<0.01)；SGRQ活动评分与mMRC、BDI高度相关（r=0.84, r=-0.91, P<0.01）；SGRQ症状评分与BODE高度相关(r=0.80,（P<0.01)；SGRQ影响评分与HDRS中度相关（r=0.57, P<0.01）。以所有患者为整体进行分析，除CCQ心理评分及HDRS外，各评分均有改善（P<0.05）；单药组CCQ较前下降（P<0.05），二联组CAT、mMRC、CCQ、SGRQ较前下降（（P<0.05），三联组CCQ及SGRQ较前下降（P<0.05），3组TDI差异无统计学意义（P>0.05）。结论 相对于mMRC，更推荐BDI及TDI进行呼吸困难评估；CAT、CCQ、SGRQ疗效反应灵敏，可用于治疗后的常规评估，其中SGRQ最为全面，时间充分的情况下，建议完善SGRQ；BODE评分相对复杂，但对于患者未来生存率有极高的预测价值；建议完善HDRS 进行慢阻肺合并抑郁的常规筛查。

关键词: 慢性阻塞性肺疾病；肺功能；调查问卷；吸入药物；疗效评估

Abstract: Objective To compare the practicability and clinical value of different evaluation systems for assessing disease severity and treatment efficacy in patients with chronic obstructive pulmonary disease (COPD). Methods We retrospectively analyzed the clinical data of 28 patients with acute exacerbation of COPD admitted to our hospital between November, 2020 and January, 2021. All the patients were assessed with percentage of predicted forced expiratory volume in 1 second (FEV1% pred), COPD assessment test (CAT), modified British Medical Research Council (mMRC), baseline dyspnea index (BDI), clinical COPD questionnaire (CCQ), St. George's respiratory questionnaire (SGRQ), BODE index, Hamilton Depression Rating Scale (HDRS) at admission and with CAT, mMRC, transition dyspnea index (TDI), CCQ, SGRQ, and HDRS at 1 month after discharge. The correlations among FEV1% pred, CAT, mMRC, BDI, CCQ, SGRQ, BODE and HDRS at admission were analyzed. We also compared the TDI and scores of CAT, mMRC, CCQ, SGRQ, and HDRS at 1 month after discharge among the patients using single (n=8), dual (n=10) or triple inhaled medications (n=10) after discharge. Results Among these patients, FEV1% pred was moderately correlated with SGRQ and BDI (r=-0.66, r=0.61; P<0.01), and CCQ activity score was closely correlated with mMRC, SGRQ activity score and BDI (r=0.82, r=0.92, r=-0.89; P<0.01). SGRQ activity score was closely correlated with mMRC and BDI (r=0.84, r=-0.91; P<0.01), and SGRQ symptom score was closely correlated with BODE (r=0.80, P<0.01). SGRQ impact score was moderately correlated with HDRS (r=0.57, P<0.01). In all the 28 patients, all the evaluation scores except for CCQ mental score and HDRS improved significantly after treatment (P<0.05). At 1 month after discharge, CCQ total score decreased significantly in single therapy group (P<0.05); CAT, mMRC, CCQ and SGRQ improved obviously in dual therapy group (P<0.05); CCQ and SGRQ scores decreased significantly in triple therapy group (P<0.05); the TDI did not differ significantly among the 3 groups (P>0.05). Conclusion For patients with COPD, BDI and TDI are recommended over mMRC for assessing dyspnea. CAT, CCQ and SGRQ allow sensitive assessment of the treatment efficacy to serve as routine evaluation tests, and among them SGRQ is the most comprehensive and is thus recommended when sufficient time is allowed. BODE is relatively complex but highly valuable for predicting the patients’survival outcomes. HDRS is recommended for routine screening of depression in patients with COPD.

Key words: chronic obstructive pulmonary disease; pulmonary function test; surveys and questionnaires; inhaled medicines; efficacy evaluation