GOLD2014与GOLD2007对COPD患者病情评估的差异

摘要

目的：比较GOLD2007与GOLD2014对COPD患者病情评估的差异。方法根据2006年松江区小昆山、新浜社区卫生服务中心入户登记资料，于2008年1—2月对慢性咳嗽或气喘且年龄≥40岁、上海市户籍者按照GOLD2007的诊断标准，分批进行肺功能检查。选择符合诊断标准的患者作为随访对象。小昆山社区卫生服务中心随访时间为2008年3月—2009年2月，新浜社区卫生服务中心随访时间为2008年4月—2009年3月。分别采用GOLD2007与GOLD2014在患者随访1年后进行病情评估，并进行一致性检验。结果711例患者中有132例符合COPD诊断，小昆山社区卫生服务中心61例，47例完成随访；新浜社区卫生服务中心71例，55例完成随访。GOLD2007评估Ⅰ期6例（5.9%），Ⅱ期21例（20.6%），Ⅲ期50例（49.0%），Ⅳ期25例（24.5%）；GOLD2014评估A级23例（22.5%），B级2例（2.0%），C级46例（45.1%），D级31例（30.4%）。一致性分析结果显示，两种评估方法存在一致性（ Kappa=0.412，P＜0.001）。将Ⅰ＋Ⅱ、Ⅲ＋Ⅳ期病例数与A＋B、C＋D级病例数合并后，两种评估方法一致性较好（ Kappa=0.948，P＜0.001）。结论两种评估方法对稳定期COPD病情评估存在一致性，但依据GOLD2014，A级患者明显增加，对临床治疗存在一定的影响。%Objective To compare the difference in evaluation of COPD patients between GOLD2007 and GOLD2014. Methods According to the registration information of Xiaokunshan CHC, Xinbang CHC in songJiang District, all patients ( aged≥40 years) with chronic cough or asthma had pulmonary function tests according to GOLD2007 diagnostic criteria from January to February 2008. The patients meeting the diagnostic criteria were enrolled as follow-up obJects. The follow-up time was from March 2008 to February 2009 in Xiaokunshan CH and from April 2008 to March 2009 in Xinbang CHC. GOLD2007 and GOLD2014 were used to evaluate the condition of the followed-up patients and consistency check was carried out. Results In the 711 patients,132 accorded with COPD criteria,61(47 completed the follow-up)in Xiaokunshan,71(55 completed the follow-up)in Xinbang. By GOLD2007 evaluation,6(5. 9%)patients were diagnosed as COPD stageⅠ,21(20. 6%)as stage Ⅱ,50(49. 0%)as stageⅢ,25(24. 5%)as stageⅣ;by GOLD2014 evaluation,23(22. 5%)patients diagnosed as grade A,2(2. 0%)as grade B,46(45. 1%)as grade C,31(30. 4%)as grade D. Consistency analysis showed that the 2 evaluation methods were consistent(Kappa=0. 412,P<0. 001). Comparing the cases of Ⅰ+Ⅱ,Ⅲ+Ⅳ stages with those of A+B,C+D grades,the consistency analysis of the 2 methods showed that the consistency was good(Kappa=0. 948, P<0. 001). Conclusion There is consistency in evaluation of stable COPD condition between 2 methods,but according to GOLD2014,the patients as grade A are significanty increased which effects the clinical treatments to some extent.