慢性阻塞性肺疾病评估测试评分对预后的评估意义

doi:10.3877/cma.j.issn.1674-6902.2017.01.008

目的

探讨慢性阻塞性肺疾病评估测试(CAT)评分与慢性阻塞性肺疾病(COPD)患者预后因素之间的相关性，明确CAT评分对COPD患者预后评估的应用价值。

方法

选取2013年1月至2015年1月我院呼吸内科住院及门诊就诊的106例COPD患者为研究对象。对106例患者治疗前后进行CAT评分、6 min步行实验(6MWD)、改良英国MRC呼吸困难指数(mMRC)、BODE(B为体质量指数，O为气道阻塞程度，D为呼吸困难分数，E为运动耐力)指数、圣乔治呼吸问卷(SGRQ)评分及肺功能的测定。采用单因素线性相关分析CAT评分与患者各临床特征之间的相关性。

结果

随着CAT评分的升高，患者6MWD、用力呼气容积(FVC)实测值、FVC实测/预测值、一秒用力呼气容积(FEV₁)实测值、FEV₁实测/预测值、FEV₁/FVC、呼气峰流速(PEF)实测值、PEF实测/预测值均明显降低(P<0.05)，而mMRC评分、BODE指数及SGRQ总评分明显升高(P<0.05)；患者经短期治疗后，CAT评分、BODE指数及SGRQ总评分均显著低于治疗前(P<0.05)，而6MWD、FEV₁实测值、FEV₁实测/预测值、FEV₁/FVC则均显著高于治疗前(P<0.05)；单因素相关分析发现，治疗前CAT评分与mMRC评分(r＝0.254，P＝0.018)、BODE指数(r＝0.426，P＝0.009)及SGRQ总评分(r＝0.563，P＝0.007)呈显著正相关，与6MWD(r＝－0.387，P＝0.008)、FVC实测值(r＝－0.181，P＝0.023)、FVC实测/预测值(r＝－0.192，P＝0.021)、FEV₁实测值(r＝－0.201，P＝0.016)、FEV₁实测/预测值(r＝－0.214，P＝0.013)及FEV₁/FVC(r＝－0.223，P＝0.012)呈显著负相关；治疗后CAT评分与mMRC评分(r＝0.304，P＝0.011)、BODE指数(r＝0.382，P＝0.010)及SGRQ总评分(r＝0.621，P＝0.004)呈显著正相关，与6MWD(r＝－0.407，P＝0.007)、FEV₁实测值(r＝－0.211，P＝0.014)、FEV₁实测/预测值(r＝－0.228，P＝0.012)及FEV₁/FVC(r＝－0.231，P＝0.011)呈显著负相关。

结论

CAT评分与COPD患者mMRC评分、BODE指数、SGRQ总评分、6MWD及肺功能指标均有较好的相关性，具有较好的预测COPD患者预后的应用价值。

关键词: 肺疾病，慢性阻塞性, 评估测试，肺疾病，慢性阻塞性, 预后, 相关性

Objective

To study the correlation between chronic obstructive pulmonary disease assessment test score (CAT) and prognostic factors of chronic obstructive pulmonary disease (COPD), and explore the clinical application value of CAT in assessing the prognosis of patients with COPD.

Methods

Au 106 patients with diagnosed COPD in the department of resiratory of our hospital from January 2013 to January 2015 were enrolled in the study. The CAT score, 6-min walking distance (6MWD), modified medical British research council (mMRC), BODE index, St George′s respiratory questionnaire (SGRQ) and pulmonary function indices were collected before and after treatment. The correlation between the CAT scores and clinical characteristics were analyzed by univariate linear correlation.

Results

With the CAT scores increased, the 6MWD, forced vital capacity (FVC) measured values, FVC observed/predicted value, forced expiratory volume in one second (FEV₁) measured values, FEV₁ observed/predicted values, FEV₁/FVC, peak expiratory flow (PEF) measured values, PEF observed/predicted values were significantly lower (P<0.05), while mMRC score, BODE index and SGRQ total score were significantly higher (P<0.05); After the short-term treatment for patients, the CAT scores, BODE index and SGRQ total scores were significantly lower than that before treatment (P<0.05), while 6MWD, FEV₁ measured values, FEV₁ observed/predicted values, FEV₁/FVC were significantly higher than that before treatment (P<0.05); The univariate analysis found that the CAT score in pre-treatment was positive correlated with mMRC scale (r=0.254, P=0.018), BODE index (r=0.426, P=0.009) and SGRQ total scores (r=0.563, P=0.007), which was negative correlated with 6MWD (r=-0.387, P=0.000), FVC measured values (r=-0.181, P=0.023), FVC observed/predicted value (r=-0.192, P=0.021), FEV₁ measured values (r=-0.201, P=0.016), FEV₁ observed/predicted values (r=-0.214, P=0.013) and FEV₁/FVC (r=-0.223, P=0.012); the CAT score in post-treatment was positive correlated with mMRC scale (r=0.304, P=0.011), BODE index (r=0.382, P=0.010) and SGRQ total scores (r=0.621, P=0.004), which was negative correlated with 6MWD (r=-0.407, P=0.000), FEV₁ measured values (r=-0.211, P=0.014), FEV₁ observed/predicted values (r=-0.228, P=0.012) and FEV₁/FVC (r=-0.231, P=0.011).

Conclusions

The CAT score has a good correlation with mMRC scale, BODE index, SGRQ, 6MWD and pulmonary function in COPD patients, suggesting which has a potential to predict the prognosis of COPD.

Key words: Chronic obstructive pulmonary disease, Chronic obstructive pulmonary disease assessment, Prognosis, Correlation

表1 不同CAT评分COPD患者的临床特征比较(±s)

临床资料	A组(n＝19)	B组(n＝41)	C组(n＝32)	D组(n＝14)
年龄(±s，岁)	65.3±10.3	67.2±11.3	66.8±16.1	67.0±13.6
BMI指数(kg/m²)	23.1±6.3	22.6±5.3	23.5±5.8	24.0±6.1
6MWD (m)	365.5±43.2	272.6±32.0^a	260.1±27.4^a	223.5±25.8^a
mMRC (分)	1.15±0.32	1.89±0.24^a	2.13±0.38^a	3.58±0.46^a
BODE指数(分)	1.2±0.6	2.8±0.5^a	3.3±0.7^a	3.7±0.5^a
SGRQ总评分(分)	31.5±9.2	43.2±8.5^a	56.3±10.2^a	68.6±8.5^a
FVC实测值(L)	3.50±0.72	2.65±0.88^a	2.44±0.95^a	2.13±0.86^a
FVC实测/预测值	105.6±12.5	86.3±8.6^a	76.4±8.0^a	70.5±9.1^a
FEV₁实测值(L)	3.24±0.85	2.35±0.75^a	2.12±0.68^a	1.86±0.47^a
FEV₁实测/预测值	82.3±8.6	75.5±7.0^a	65.3±7.2^a	57.8±6.6^a
FEV₁/FVC(%)	68.5±6.9	59.4±5.8^a	58.7±7.0^a	50.2±6.3^a
PEF实测值(L/s)	5.64±1.2	3.92±1.0^a	3.64±1.1^a	3.55±1.2^a
PEF实测/预测值	68.5±7.1	49.5±6.3^a	46.1±5.0^a	43.0±5.6^a

表1 不同CAT评分COPD患者的临床特征比较(±s)

临床资料	A组(n＝19)	B组(n＝41)	C组(n＝32)	D组(n＝14)
年龄(±s，岁)	65.3±10.3	67.2±11.3	66.8±16.1	67.0±13.6
BMI指数(kg/m²)	23.1±6.3	22.6±5.3	23.5±5.8	24.0±6.1
6MWD (m)	365.5±43.2	272.6±32.0^a	260.1±27.4^a	223.5±25.8^a
mMRC (分)	1.15±0.32	1.89±0.24^a	2.13±0.38^a	3.58±0.46^a
BODE指数(分)	1.2±0.6	2.8±0.5^a	3.3±0.7^a	3.7±0.5^a
SGRQ总评分(分)	31.5±9.2	43.2±8.5^a	56.3±10.2^a	68.6±8.5^a
FVC实测值(L)	3.50±0.72	2.65±0.88^a	2.44±0.95^a	2.13±0.86^a
FVC实测/预测值	105.6±12.5	86.3±8.6^a	76.4±8.0^a	70.5±9.1^a
FEV₁实测值(L)	3.24±0.85	2.35±0.75^a	2.12±0.68^a	1.86±0.47^a
FEV₁实测/预测值	82.3±8.6	75.5±7.0^a	65.3±7.2^a	57.8±6.6^a
FEV₁/FVC(%)	68.5±6.9	59.4±5.8^a	58.7±7.0^a	50.2±6.3^a
PEF实测值(L/s)	5.64±1.2	3.92±1.0^a	3.64±1.1^a	3.55±1.2^a
PEF实测/预测值	68.5±7.1	49.5±6.3^a	46.1±5.0^a	43.0±5.6^a

表2 106例COPD患者治疗前后相关临床特征比较(±s)

预后因素	A、B组(＝60)		C、D组(＝46)
预后因素	治疗前	治疗后	治疗前	治疗后
平均CAT评分	12.39±3.54	10.60±2.65^a	27.20±4.04	18.30±2.67^a
BMI指数(kg/m²)	22.70±6.32	23.50±5.06	23.60±7.12	24.10±6.51
6MWD (m)	302.1±33.2	325.6±25.7^a	248.9±35.4	284.5±34.7^a
mMRC (分)	1.48±0.22	1.02±0.26^a	2.67±0.47	2.03±0.35^a
BODE指数(分)	2.4±0.7	1.2±0.5^a	3.5±0.6	2.2±0.4^a
SGRQ总评分(分)	36.3±9.4	28.1±5.8^a	62.6±9.5	39.5±8.4^a
FVC实测值(L)	2.91±0.97	3.21±1.24	2.34±1.19	2.85±1.21
FVC实测/预测值	92.4±12.1	94.0±13.4	74.6±8.6	80.4±9.0
FEV₁实测值(L)	2.63±0.79	2.95±0.45^a	2.04±0.97	2.68±0.35^a
FEV₁实测/预测值	79.7±8.6	85.4±9.0^a	63.0±7.4	72.2±8.3^a
FEV₁/FVC(%)	62.9±6.3	75.8±7.2^a	56.1±4.8	63.4±5.3^a
PEF实测值(L/s)	4.43±1.25	5.32±1.35	3.61±1.04	4.35±1.34
PEF实测/预测值	55.5±10.2	58.4±8.6	45.1±6.7	54.7±6.8

表2 106例COPD患者治疗前后相关临床特征比较(±s)

预后因素	A、B组(＝60)		C、D组(＝46)
预后因素	治疗前	治疗后	治疗前	治疗后
平均CAT评分	12.39±3.54	10.60±2.65^a	27.20±4.04	18.30±2.67^a
BMI指数(kg/m²)	22.70±6.32	23.50±5.06	23.60±7.12	24.10±6.51
6MWD (m)	302.1±33.2	325.6±25.7^a	248.9±35.4	284.5±34.7^a
mMRC (分)	1.48±0.22	1.02±0.26^a	2.67±0.47	2.03±0.35^a
BODE指数(分)	2.4±0.7	1.2±0.5^a	3.5±0.6	2.2±0.4^a
SGRQ总评分(分)	36.3±9.4	28.1±5.8^a	62.6±9.5	39.5±8.4^a
FVC实测值(L)	2.91±0.97	3.21±1.24	2.34±1.19	2.85±1.21
FVC实测/预测值	92.4±12.1	94.0±13.4	74.6±8.6	80.4±9.0
FEV₁实测值(L)	2.63±0.79	2.95±0.45^a	2.04±0.97	2.68±0.35^a
FEV₁实测/预测值	79.7±8.6	85.4±9.0^a	63.0±7.4	72.2±8.3^a
FEV₁/FVC(%)	62.9±6.3	75.8±7.2^a	56.1±4.8	63.4±5.3^a
PEF实测值(L/s)	4.43±1.25	5.32±1.35	3.61±1.04	4.35±1.34
PEF实测/预测值	55.5±10.2	58.4±8.6	45.1±6.7	54.7±6.8

表3 治疗前后COPD患者CAT评分与预后因素的相关性分析

预后因素	治疗前(n＝106)		治疗后(n＝106)
预后因素	r值	P值	r值	P值
BMI指数(kg/m²)	0.027	0.420	0.030	0.343
6MWD (m)	－0.387	0.008	－0.407	0.007
mMRC (分)	0.254	0.018	0.304	0.011
BODE指数(分)	0.426	0.009	0.382	0.010
SGRQ总评分(分)	0.563	0.007	0.621	0.004
FVC实测值(L)	－0.181	0.023	0.057	0.062
FVC实测/预测值	－0.192	0.021	0.074	0.055
FEV₁实测值(L)	－0.201	0.016	－0.211	0.014
FEV₁实测/预测值	－0.214	0.013	－0.228	0.012
FEV₁/FVC(%)	－0.223	0.012	－0.231	0.011
PEF实测值(L/s)	0.054	0.057	0.062	0.051
PEF实测/预测值	0.049	0.072	0.070	0.072

表3 治疗前后COPD患者CAT评分与预后因素的相关性分析

预后因素	治疗前(n＝106)		治疗后(n＝106)
预后因素	r值	P值	r值	P值
BMI指数(kg/m²)	0.027	0.420	0.030	0.343
6MWD (m)	－0.387	0.008	－0.407	0.007
mMRC (分)	0.254	0.018	0.304	0.011
BODE指数(分)	0.426	0.009	0.382	0.010
SGRQ总评分(分)	0.563	0.007	0.621	0.004
FVC实测值(L)	－0.181	0.023	0.057	0.062
FVC实测/预测值	－0.192	0.021	0.074	0.055
FEV₁实测值(L)	－0.201	0.016	－0.211	0.014
FEV₁实测/预测值	－0.214	0.013	－0.228	0.012
FEV₁/FVC(%)	－0.223	0.012	－0.231	0.011
PEF实测值(L/s)	0.054	0.057	0.062	0.051
PEF实测/预测值	0.049	0.072	0.070	0.072

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Prognostic values of chronic obstructive pulmonary disease assessment test score on chronic obstructive pulmonary disease

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Prognostic values of chronic obstructive pulmonary disease assessment test score on chronic obstructive pulmonary disease