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

摘要

目的 探讨慢性阻塞性肺疾病评估测试(CAT)评分对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床评估价值及意义.方法 采用前瞻性观察性研究方法,选择2011年2月至2016年7月嘉兴市第二医院呼吸内科收治的AECOPD患者,均进行CAT评分并测定肺功能.根据肺功能等级将患者分为Ⅱ级、Ⅲ级、Ⅳ级组,比较3组1秒用力呼气容积(FEV1)和FEV1/用力肺活量(FVC)比值的差异;根据CAT评分将患者分为2级、3级、4级3组,比较3组住院时间及住院费用的差异.CAT评分与肺功能指标间的相关性采用Spearman相关分析法.结果 共入选135例AECOPD患者,均纳入分析;平均FEV1为(0.42±0.16)L,FEV1/FVC为0.44±0.13,CAT评分为(26.64±5.43)分.相关分析显示,CAT评分与FEV1、FEV 1/FVC均呈显著负相关(r值分别为-0.691、-0.728,均P＜ 0.001).随肺功能等级升高,AECOPD患者FEV1和FEV1/FVC逐渐下降(Ⅱ级、Ⅲ级、Ⅳ级组分别为0.62±0.07、0.40±0.06、0.25±0.03和0.64±0.07、0.40±0.06、0.33±0.06),CAT评分则逐渐升高(分:20.03±3.36、28.30±3.31、30.18±3.86,均P＜0.01);随CAT评分分级升高,AECOPD患者住院费用(元)和住院时间(d)均明显增加(2级、3级、4级组分别为6214.09±1396.16、8 339.31±1866.46、9600.97±4339.87和7.54±1.62、9.52±2.21、14.85±5.62,均P＜0.01).结论 CAT评分与AECOPD患者病情严重程度有一定相关性,是衡量其生活质量的一项可靠工具.%Objective To explore the clinical value and significance of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) in patients with acute exacerbation of COPD (AECOPD).Methods A prospective observational study was conducted,AECOPD patients were admitted to the Department of Respiration Medicine in Jiaxing Second Hospital from February 2011 to July 2016 were enrolled,and they all underwent CAT assessment test and lung function examination.The patients were assigned to Ⅱ,Ⅲ and Ⅳ grade groups according to the lung function level,and the difference of forced expiratory end volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) ratio were compared among the three groups;the patients were also assigned into 2,3 and 4 grade groups according to CAT scores,and the difference of length of stay in the hospital and hospitalization expenses were compared among the three groups.Spearman correlation analysis was used to analyze the correlations between the CAT score and lung function indexes.Results One hundred and thirty-five patients with AECOPD were accepted and all of their clinical data were analyzed in the study.Their mean FEV1 was (0.42±0.16) L,FEV1/FVC was 0.44 ±0.13 and CAT score was 26.64 ± 5.43.The correlation analyses showed:there were significant negative correlations between CAT score and FEV1,FEV1/FVC (r value was-0.691,-0.728,both P ＜ 0.001).With the elevation of lung function grade,FEV1 and FEV1/FVC were decreased gradually (1Ⅱ,Ⅲ,Ⅳ grade groups were 0.62±0.07,0.40±0.06,0.25±0.03 and 0.64±0.01,0.40±0.00,0.33±0.06 respectively),while CAT score raised gradually (20.03 ± 3.36,28.30 ± 3.31,30.18±3.86,all P ＜ 0.01);with the CAT score getting higher and higher,hospitalization expenses (yuan) and the length of stay in hospital (day) of patients with AECOPD were increased significantly (2,3,4 grade groups:expense were 6214.09±1396.16,8339.31±1866.46,9600.97±4339.87,and length of stay in hospital were 7.54± 1.62,9.52±2.21,14.85 ±5.62,respectively,all P ＜ 0.01).Conclusion CAT is a reliable tool to measure the life quality of AECOPD patients and has certain relevance to the severity and prognosis of the disease.