慢性阻塞性肺疾病评估测试评分与慢性阻塞性肺疾病预后因素相关性分析

目的观察慢性阻塞性肺疾病(COPD)评估测试(CAT)评分与COPD患者疾病预后因素的相关性,以探讨CAT评分在判断预后方面的可能价值。方法选取从2011年7月至2012年9月在我院门诊就诊的81例初诊及既往无使用吸入性糖皮质激素(ICS)/长效β2受体激动剂(LABA)或长效胆碱能药物(LAMA)病史的COPD患者为研究对象,根据2011年版COPD全球倡议指南(GOLD)分为A(低危、症状轻)、B(低危、症状重)、C(高危、症状轻)、D(高危、症状重)组,给予ICS/LABA或ICS/LABA+LAMA治疗,收集患者治疗前及治疗3个月后相关资料,包括CAT评分、年龄、吸烟量、肺功能指标、体质指数(BMI)、运动耐力指标6min步行距离(6MWD)、改良英国MRC呼吸困难指数(mMRC)及诊断前12个月COPD急性加重(AECOPD)次数,分析患者临床特征并进行相关性分析。结果 81例COPD患者平均年龄(66.27±8.52)岁,男性占88.89%,吸烟者占85.19%;治疗前A、B、C、D组比例分别为8.64%、30.86%、4.94%及55.56%;CAT评分≥10分组一秒用力呼气容积(FEV1)及其占预计值百分比(FEV1%Pred)、用力呼气容积(FVC)及其占预计值百分比(FVC%Pred)、呼气峰流速(PEF)及其占预计值百分比(PEF%Pred)、6MWD均较CAT评分<10分组降低(P<0.05),CAT评分为10～20分组、20～30分组及≥30分组上述指标间差异无统计学意义。CAT评分≥20分组mMRC分级及AECOPD次数较CAT评分<10分组升高(P<0.05),不同分组间FEV1/FVC差异无统计学意义。CAT评分与mMRC分级(治疗前r2=0.417,P<0.001;治疗后r2=0.19,P<0.001)、6MWD(治疗前r2=0.320,P<0.001;治疗后r2=0.19,P<0.001)及治疗前FEV1(r2=0.177,P=0.0015)、FEV1%Pred(r2=0.125,P=0.002)、PEF(r2=0.164,P=0.0024)、PEF%Pred(r2=0.129,P=0.0076)、FVC(r2=0.098,P=0.021)、FVC%Pred(r2=0.094,P=0.024)、FEV1/FVC(r2=0.101,P=0.0057)、AECOPD次数(r2=0.059,P=0.028)有关,与吸烟量(r2=0.041,P=0.083)、BMI(r2=0.00,P=0.89)及治疗后FEV1(r2=0.01,P=0.22)、FEV1%Pred(r2=0.003,P=0.09)无关。结论 COPD好发于男性吸烟者,其中D组比例最高。CAT评分与治疗前后mMRC分级及运动耐力指标相关性均较好,具有判断COPD患者预后的潜在价值。

Relationship between chronic obstructive pulmonary disease (COPD) assessment test score and prognostic factors of COPD patients

Objective: To observe the correlation between CAT score and prognostic factors in patients with COPD and to investigate the clinical significance of CAT score. Methods: 81 patients with newly diagnosed or without using ICS/LABA or LAMA patients with history of COPD were recruited into study and given ICS/LABA or ICS/LABA+LAMA treatment for 3 months, the related data were collected before treatment and after treatment, including the CAT score, age, smoking history, pulmonary function test, body mass index (BMI), 6 minutes walking distance (6MWD), modified MRC dyspnea index (mMRC ) and the times of acute exacerbation in previous one year, which were used to find out the clinical characteristics of patients and the correlation analysis between CAT score and all the other data. Results: the average age of the 81 cases of COPD patients were 66.27± 8.52 years, 88.9% males, smokers accounted for 85.19%; the proportion of A, B, C, D group were respectively 8.64%, 30.86%, 4.93% and 55.56% before treatment. The FEV1, FEV1%pred, FVC, FVC%pred, PEF, PEF%pred, 6MWD were less than CAT<10 group significantly; mMRC and times of AECOPD in CAT>20 group were more than CAT<10 group significantly. No significant difference of FEV1/FVC occurred in different CAT score groups. The CAT score significantly correlated with mMRC, 6MWD, FEV1, FEV1%pred, PEF, PEF%pred, FVC, FVC%pred, FEV1/FVC, AECOPD number and not with the quantity of smoking, BMI before treatment. The CAT score had a significant correlation with mMRC, 6MWD and not with FEV1 and FEV1% after the treatment. Conclusions: COPD is prone to occur in the male smokers with the highest proportion of D group. There is a good correlation between CAT score and mMRC, exercise endurance, the correlation between CAT score and lung function results is affected by drug treatmen; CAT score can not reflect the pulmonary function and severity of the disease, is suitable for simple evaluation of quality of life in patients with COPD, prediction of pulmonary function level before treatment and rapid assessment of curative effect.