慢性阻塞性肺疾病评估测试方法的比较研究

摘要

目的 运用慢性阻塞性肺疾病(慢阻肺)评估测试量表(CAT)、改良英国医学研究理事会呼吸困难指数(mMRC)、肺功能及既往1年急性加重次数四种方式分别对慢阻肺患者的症状及未来急性加重风险进行评估,对其结果进行比较,并探讨不同方法评估的灵敏性.方法 对284例慢阻肺患者进行调查,研究内容包括患者的一般情况、CAT评分、mMRC分级、既往1年急性加重次数和肺功能测定结果,并对结果进行统计学分析.结果 284例病人,其中93例病人CAT评分≥10和mMRC<2,7例病人CAT<10和mMRC≥2;其中45例病人FEV1%≥50%和既往1年急性加重次数≥2,65例病人FEV1%<50%和既往1年急性加重次数<2;慢阻肺CAT评分与mMRC分级两种症状评估方法具有正相关和一般的一致性(r=0.828,P<0.01;Kappa系数分别为0.384,0.291,P=0.000).然而CAT评分的灵敏性(96.73%)高于mMRC(56.54%);既往1年急性加重次数与肺功能两种未来风险预测方法之间具有负相关及一般的一致性(r=-0.547,P<0.01;Kappa系数分别为0.393,0.324,P=0.000).其中肺功能对风险评估的灵敏性(78.16%)高于急性加重的次数(68.45%).结论 CAT评分相对于mMRC分级其涵盖内容更丰富,对慢阻肺的症状评估其准确性及灵敏性更高;在对慢阻肺未来急性加重风险评估中,肺功能优于既往急性加重的次数,可准确的反映患者病情严重程度.%Objective To evaluate the risks and results and to investigate the sensitivity by applying COPD assessment test ( CAT) , modified British medical research council ( mMRC) scale, lung function tests and the exacerbation times during one year of patients with COPD. Methods A total of 284 patients with COPD were selected to collect their general information, the times of exacerbation during past year, CAT score, mMRC grade and results of lung function tests. The results were conducted by statistical method. Results 284 patients included 93 cases had a CAT score≥10 and an mMRC grade≤1, 7 cases had a CAT score <10 and an mMRC grade≥2. 65 patients had a predicted forced expiratory volume in one second ( FEV1%) <50% with less than twice acute exacerbation, while 45 patients had a predicted FEV1%≥50% with twice or more acute exacerbation. The score of CAT in COPD was positively correlated with mMRC, and general consistency between each other (r=0. 828, P<0. 01;Kappa 0. 384, 0. 291, P=0. 000). CAT was more sensitive than mMRC in evaluating symptoms of COPD, with a sensitivity of 96. 73%. The sensitivity of mMRC was 56. 54%. The pulmonary function was negatively correlated with the real number of AECOPD, and general consistency between each other ( r=0. 547, P<0. 01; Kappa 0. 393, 0. 324, P=0. 000). Their lung function was more sensitive than the real number of AECOPD events recorded in predicting the risk of AECOPD in future, and its sensitivity was 78. 16%, while the sensitivity of the real number of AECOPD events was 68. 45%. Conclusion The CAT score contains more rich contents than mMRC classification, its accuracy and sensitivity is higher than mMRC in symptoms of evaluation. The lung function classification is better than the real number of acute exacerbation in past year, and it can accurately reflect the severity of COPD.