CAJ | 학술논문

目的探讨2011年慢性阻塞性肺疾病全球倡议(GOLD)对COPD稳定期患者疾病评估和治疗带来的变化和影响.方法将269例COPD患者进行了症状、肺功能、急性加重情况的记录,并根据2006及2011 GOLD策略进行了分期和分组的分析,比较新旧策略对患者治疗选择的影响.结果用CAT评估与mMRC评估比较,增加了症状较多组(B和D)的患者例数,两个评估方法中C和D组患者总数相仿.对比2006及2011 GOLD策略,GOLD 2006中Ⅱ级患者在GOLD 2011中分组变化尤为突出;新分组导致中度COPD患者中的44例(16.4％)需要改变初始治疗,急性加重的风险评估是影响分组及治疗选择的最主要的因素,FEV1与临床症状和AECOPD频率虽有相关性(P＜0.01),但FEV1并不是评估COPD病情的敏感指标.结论 2011 GOLD策略对COPD稳定期患者的评估更加全面,但在临床操作上略显复杂,而且主要影响了中度COPD患者的分组及治疗选择的改变,AECOPD频率对COPD风险分级的影响非常大.
목적 탐토2011년만성조새성폐질병전구창의(GOLD)대COPD은정기환자질병평고화치료대래적변화화영향.방법 장269례COPD환자진행료증상、폐공능、급성가중정황적기록,병근거2006급2011 GOLD책략진행료분기화분조적분석,비교신구책략대환자치료선택적영향.결과 용CAT평고여mMRC평고비교,증가료증상교다조(B화D)적환자례수,량개평고방법중C화D조환자총수상방.대비2006급2011 GOLD책략,GOLD 2006중Ⅱ급환자재GOLD 2011중분조변화우위돌출;신분조도치중도COPD환자중적44례(16.4％)수요개변초시치료,급성가중적풍험평고시영향분조급치료선택적최주요적인소,FEV1여림상증상화AECOPD빈솔수유상관성(P＜0.01),단FEV1병불시평고COPD병정적민감지표.결론 2011 GOLD책략대COPD은정기환자적평고경가전면,단재림상조작상략현복잡,이차주요영향료중도COPD환자적분조급치료선택적개변,AECOPD빈솔대COPD풍험분급적영향비상대.
Objective Study the change and influence of assessment and treatment to stable patient with chronic obstructive pulmonary disease (COPD) by Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011.Methods Two hundred and sixty-nine stable COPD patients' data were collected including symptom,lung function,acute exacerbation.Analyzing the staging and group according to GOLD 2006 and GOLD 2011.Compare the influence of treatment strategies with the old and new initiative.Results Evaluate patients' symptoms with COPD assessment test (CAT) and modified british medical research council (mMRC).The number of more symptoms patients (B group and D group) was increased by CAT and the total number of patients in C group and D group is similar.Comparing GOLD 2006 with GOLD 2011,44 patients (16.4 ％) in stage Ⅱ needed to change the initial treatment.Risk classification of acute exacerbation is the main factor affecting the group and treatment.FEV1 has positive correlation with the clinical symptoms and the frequency of acute exacerbation of COPD (AECOPD)(P ＜0.01),is also an important objective index of symptom evaluation and risk prognosis.Conclusions Assessing the stable COPD patients with GOLD 2011 is more comprehensive in clinical operation.The results mainly influence the group and treatment of patients in stage Ⅱ and to prognose AECOPD.Though FEV1 is related with the symptom and frequency of AECOPD,but FEV1 is not a sensitive indicator to assess of COPD.The frequency of AECOPD has large impact on COPD risk classification.