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中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (05) : 888 -893. doi: 10.3877/cma.j.issn.1674-6902.2026.05.026

综述

精准管理模式用于慢性阻塞性肺疾病症状群干预策略中的应用研究现状与展望
李兴雯1, 杨丽2, 王关嵩2, 刘佳1,†()   
  1. 1400037 重庆,陆军(第三)军医大学第二附属医院中医科
    2400037 重庆,陆军(第三)军医大学第二附属医院呼吸与危重症医学中心
  • 收稿日期:2026-04-03 出版日期:2026-10-25
  • 通信作者: 刘佳

Current status and prospects of research on the application of precision management models in intervention strategies for symptom clusters of chronic obstructive pulmonary disease

Xingwen Li, Li Yang, Guansong Wang   

  • Received:2026-04-03 Published:2026-10-25
引用本文:

李兴雯, 杨丽, 王关嵩, 刘佳. 精准管理模式用于慢性阻塞性肺疾病症状群干预策略中的应用研究现状与展望[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(05): 888-893.

Xingwen Li, Li Yang, Guansong Wang. Current status and prospects of research on the application of precision management models in intervention strategies for symptom clusters of chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(05): 888-893.

慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)是一种以持续性气流受限为特征的异质性慢性气道疾病,患者除典型咳嗽、咳痰、喘息症状外,常并发疲乏、焦虑抑郁、睡眠障碍、骨骼肌功能减退等多维度症状群(symptom cluster),传统单一症状导向的干预模式难以全面覆盖其复杂临床表现,导致症状控制不佳、急性加重频繁及生活质量下降。近年来,随着精准医学理念在呼吸疾病领域的深入,以"可治疗特质(treatable traits)"为核心、结合表型/内型分型、生物标志物指导及多组学技术的精准管理模式,逐渐被引入COPD症状群的识别、评估与个体化干预。COPD症状群的概念内涵与常用测评工具,分析呼吸困难-疲乏-焦虑三联症状群及咳痰-感染易感-急性加重症状群的流行病学特征及发生机制。其次为当前精准管理模式在COPD症状群干预中的应用研究现状,包括基于嗜酸性粒细胞计数等生物标志物指导吸入治疗以减轻气道炎症相关症状群、频繁急性加重表型制定预防性干预方案、衰弱与营养状态评估实施肺康复联合营养支持以改善疲乏-活动耐量下降症状群、以及数字化可穿戴设备进行症状群动态监测与预警等内容。归纳现有研究的局限性,如症状群界定标准尚未统一、精准分层工具在基层普及率低、随机对照试验证据不足及卫生经济学评价缺乏等。展望未来发展方向,提出建立标准化COPD症状群分类体系、整合多组学数据与机器学习构建动态症状群预测模型、开发"评估-分层-干预-反馈"闭环式精准管理路径、推进远程医疗与人工智能(artificial intelligence, AI)辅助决策在社区COPD症状群全程管理中的应用,以期为提高我国COPD患者症状控制水平、降低急性加重风险及改善预后提供理论依据具有临床意义。

1
de Oca Maria Montes, Rogelio Perez-Padilla, Bartolome Celli, et al.The global burden of COPD: epidemiology and effect of prevention strategies[J]. Lancet Respir Med, 2025, 13(8): 709-724.
2
de Oca MM, Perez-Padilla R, Celli B, et al. The global burden of COPD: epidemiology and effect of prevention strategies[J]. Lancet Respir Med, 2025, 13(8): 709-724.
3
罗宸婧,盛芳芳,张静,等. 以全球视角对中国慢性阻塞性肺疾病负担及未来趋势分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(6): 855-860.
4
Lin P, Shen C, Li Q, et al. A systematic review and meta-analysis of chronic obstructive pulmonary disease in asia: risk factors for readmission and readmission rate[J]. BMC Pulm Med, 2024, 24(1): 388.
5
郑旭峰,陈法桂,高永槟,等. 83例慢性阻塞性肺疾病急性加重期D-二聚体与白蛋白比值、CT参数和肺功能相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(2): 227-233.
6
Fei Fei, Koffman Jonathan, Zhang Xiaohan, et al. Synergistic impact of the symptom cluster on health-related quality of life in patients with chronic obstructive pulmonary disease: a secondary data analysis[J].Clin Nurs Res, 2022, 31(6): 991-999.
7
Cai S, Yao J, Han M, et al. The effect of cognition in combination with an ACBT on dyspnea-related kinesiophobia in patients with moderate to severe COPD: Quasirandomized controlled trial study[J]. Geriatr Nurs, 2024, 56: 138-147.
8
Wang W, Wang L, Fan R, et al. Relationship among depressive symptoms, dyspnea-related fear and sarcopenia in patients with chronic obstructive pulmonary disease: The mediating effect of physical activity[J]. Chron Respir Dis, 2025, 22: 14799731251335028.
9
GOLD GIFC. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2026 report[EB/OL][0003/9/1].

URL    
10
Lim KE, Kim SR, Kim HK, et al. Symptom clusters and quality of life in subjects with COPD[J]. Respir Care, 2017, 62(9): 1203-11.
11
陈庆梅,崔妙玲,麻月娥,等. 慢性阻塞性肺疾病急性加重期患者症状群及前哨症状的调查研究[J]. 中华护理杂志,2022, 57(23): 2891-2897.
12
Xu M, Yu C, Lin X, et al. Identification of symptom clusters and change trajectories in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Heliyon, 2024, 10(13): e33745.
13
Yohannes AM, Murri MB, Hanania NA, et al. Depressive and anxiety symptoms in patients with COPD: A network analysis[J]. Respir Med, 2022, 198: 106865.
14
Yang Z, Cui M, Zhang X, et al. Identification of symptom clusters and their influencing factors in subgroups of chinese patients with acute exacerbation of chronic obstructive pulmonary disease[J]. J Pain Symptom Manage, 2020, 60(3): 559-567.
15
Jun J, Park C, Fritschi C, et al. Behavioral interventions and symptom cluster change in adults with chronic obstructive pulmonary disease and insomnia[J]. Heart Lung, 2024, 64: 6-13.
16
Lee J, Nguyen HQ, Jarrett ME, et al. Effect of symptoms on physical performance in COPD[J]. Heart Lung, 2018, 47(2): 149-156.
17
Yang M, Wang Z, Zhao Y, et al. Association of patient-reported outcome patterns and major clinical factors with frailty in stable COPD[J]. Int J Chron Obstruct Pulmon Dis, 2025, 20: 1927-1937.
18
Yang J, Xu N, Liang M. A longitudinal study on the correlation between symptom clusters and disease-specific health status in older adults with chronic obstructive pulmonary disease during pulmonary rehabilitation[J]. Front Public Health, 2026, 14: 1720782.
19
Yu C, Xu M, Pang X, et al. Symptom network and subgroup analysis in patients with exacerbation of chronic pbstructive pulmonary disease: a cross-sectional study[J]. Int J Chron Obstruct Pulmon Dis, 2025, 20: 181-192.
20
张巧云,刘娟,汪曼玉,等. 慢性阻塞性肺疾病病人急性加重期症状群发展轨迹的纵向研究[J]. 蚌埠医科大学学报,2025, 50(9): 1286-1292.
21
Zhang W, Cui Y, Sun L, et al. Correlation between serum inflammatory factors and psychosomatic syndrome in patients with chronic obstructive pulmonary disease: an observational study[J]. Front Psychiatry, 2025, Volume 16-2025.
22
Sharma K, Subba HK, Poudyal S, et al. Effect of self-management intervention on patients with chronic obstructive pulmonary diseases, Chitwan, Nepal[J]. PLoS One, 2024, 19(1): e296091.
23
Kochamat A, Harnirattisai T, Juratovac E. The effects of a symptom management program on symptom experience and physical function in Thai adults with chronic obstructive pulmonary disease: A single-blind randomized controlled trial study[J]. Belitung Nurs J, 2024, 10(4): 378-388.
24
Zhou Y, Ampon MR, Abramson MJ, et al. Respiratory symptoms, disease burden, and quality of life in australian adults according to GOLD spirometry grades: data from the BOLD australia study[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18: 2839-2847.
25
Hurst JR, Han MK, Singh B, et al. Prognostic risk factors for moderate-to-severe exacerbations in patients with chronic obstructive pulmonary disease: a systematic literature review[J]. Respir Res, 2022, 23(1): 213.
26
Group BP. Chronic obstructive pulmonary disease (COPD)-BMJ Best Practice[EB/OL][0003/9/1].

URL    
27
Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease[J]. N Engl J Med, 2004, 350(10): 1005-1012.
28
Golpe R, Figueira-Gonçalves JM, Esteban C, et al. A novel figure and algorithm for the GOLD-ABE classification: additional comments[J]. Arch Bronconeumol, 2023, 59(12): 846-847.
29
Jones PW, Quirk FH, Baveystock CM, et al. A self-complete measure of health status for chronic airflow limitation. The St. George′s Respiratory Questionnaire[J]. Am Rev Respir Dis, 1992, 145(6): 1321-1327.
30
Jones PW, Harding G, Berry P, et al. Development and first validation of the COPD assessment test[J]. Eur Respir J, 2009, 34(3): 648-654.
31
van der Molen T, Willemse BWM, Schokker S, et al. Development, validity and responsiveness of the Clinical COPD Questionnaire[J]. Health Qual Life Outcomes, 2003, 1: 13.
32
Guyatt GH, Berman LB, Townsend M, et al. A measure of quality of life for clinical trials in chronic lung disease[J]. Thorax, 1987, 42(10): 773-778.
33
王明航,李建生,余学庆,等. 成人COPD-QOL量表在慢性阻塞性肺疾病稳定期应用的信度和效度评价[J]. 辽宁中医杂志,2010, 37(12): 2320-2323.
34
杨铮,李晓梅,万崇华,等. 慢性阻塞性肺疾病患者生命质量测定量表的研制与考评[J]. 中国全科医学,2007(13): 1080-1083.
35
Bestall JC, Paul EA, Garrod R, et al. Usefulness of the medical research council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease[J]. Thorax, 1999, 54(7): 581-586.
36
Jones PW, Wang C, Chen P, et al. The development of a COPD exacerbation recognition tool (CERT) to help patients recognize when to seek medical advice[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17: 213-222.
37
李春阳,王佳佳,卫梦雨,等. 慢性阻塞性肺疾病急性加重期患者报告结局测评工具研究现状[J]. 中国全科医学,2024, 27(31): 3896-3904.
38
Care NOFC, Control NIFC, Disease NCRC, et al. [National implementation guideline for prevention and management of chronic obstructive pulmonary disease in primary care (2025)][J]. Zhonghua jie he he hu xi za zhi=Zhonghua jiehe he huxi zazhi=Chinese journal of tuberculosis and respiratory diseases, 2025, 48: 1-19.
39
Parekh TM, Ramachandran R, Kim Y, et al. Psychobiologic correlates of stress in individuals with COPD[J]. Chronic Obstr Pulm Dis, 2025, 12(3): 213-222.
40
Kostikas K, Dimakou K, Gourgoulianis K, et al. A real-world study on the day and night-time symptoms among greek COPD patients who recently initiated treatment with dual bronchodilation: the DANICO study[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17: 2027-2041.
41
Yu Z, Huang H, Fang S, et al. The effectiveness of respiratory muscle training on the duration and severity of respiratory symptoms in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis[J]. Can Respir J, 2026, 2026: 6434649.
42
Gao J, Cui S, Jiang Y, et al. Theory-guided eHealth literacy support for tele-pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease: A randomized controlled trial[J]. Digit Health, 2026, 12: 620069211.
43
Jun J, Park C, Fritschi C, et al. Behavioral interventions and symptom cluster change in adults with chronic obstructive pulmonary disease and insomnia[J]. Heart Lung, 2024, 64: 6-13.
44
Bruland Andresen V, Schmid W, Låstad T, et al. "It was 15 minutes without pain" -a mixed methods pilot study on the implementation of music therapy for hospitalised patients with incurable lung disease[J]. Eur Clin Respir J, 2025, 12(1): 2565852.
45
Liu W, Liu X, Huang Y, et al. Tai Chi as a complementary exercise for pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomised controlled trial[J]. Complement Ther Med, 2023, 78: 102977.
46
Tian X, Yi L, Liu X, et al. Relationship between social support, symptom burden, dyspnea, perceived stress, perceived stigma, coping styles, and psychological distress in patients with stable COPD: a structural equation model[J]. Int J Chron Obstruct Pulmon Dis, 2025, 20: 2183-2198.
47
Verduri A, Clini E, Carter B, et al. Impact of frailty on symptom burden in chronic obstructive pulmonary disease[J]. J Clin Med, 2024, 13(4): 984.
48
Mulpuru S, Chin M, Hasimja D, et al. Pilot study evaluating frailty-focused care for hospitalised patients with chronic obstructive pulmonary disease[J]. BMJ Open Qual, 2025, 14(3): e003366.
49
Stephenson H, Roberts M, Klimkeit E, et al. Uncovering undernutrition in chronic obstructive pulmonary disease: Beyond body mass index[J]. Respir Med, 2022, 205: 107026.
50
Kohlbrenner D, Kuhn M, Manettas A, et al. Low-load blood flow restriction strength training in patients with COPD: a randomised single-blind pilot study[J]. Thorax, 2024, 79(4): 340-348.
51
Yu Z, Huang H, Fang S, et al. The effectiveness of respiratory muscle training on the duration and severity of respiratory symptoms in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis[J]. Can Respir J, 2026, 2026: 6434649.
52
Özel A, Tütün Yümin E, Konuk S. Comparative effects of square-stepping and strengthening exercises on cognitive and balance functions in chronic obstructive pulmonary disease: a randomized clinical trial[J]. PeerJ, 2025, 13: e19792. DOI:10.7717/peerj.19792.
53
Grosbois J, Gephine S, Kyheng M, et al. Physical and affective components of dyspnoea are improved by pulmonary rehabilitation in COPD[J]. BMJ Open Respir Res, 2022, 9(1): e001160.
54
Bekelman DB, Feser W, Morgan B, et al. Nurse and social worker palliative telecare team and quality of life in patients with COPD, heart failure, or interstitial lung disease: the ADAPT randomized clinical trial[J]. JAMA, 2024, 331(3): 212-223.
55
Feng L, Ji H, Yang Q, et al. The relationship between the development trajectory of symptom burden and exercise adherence during remote pulmonary rehabilitation in olderly patients with COPD[J]. Front Med (Lausanne), 2025, 12: 1665349.
56
Hua J, Yang Z, Cheng Q, et al. Prevention of exacerbation in patients with moderate-to-very severe COPD with the intent to modulate respiratory microbiome: a pilot prospective, multi-center, randomized controlled trial[J]. Front Med (Lausanne), 2023, 10: 1265544.
57
Bourbeau J, Bhutani M, Hernandez P, et al. 2023 canadian thoracic society guideline on pharmacotherapy in patients with stable COPD[J]. Chest, 2023, 164(5): 1159-1183.
58
Bell Alexander J, Ram Sundaresh, Labaki Wassim W, et al.Temporal exploration of chronic obstructive pulmonary disease phenotypes: insights from the COPDGene and SPIROMICS cohorts[J]. Am J Respir Crit Care Med, 2025, 211(4): 569-576.
59
何冬雪,吴红梅,李建洁,等. 可穿戴设备在慢性阻塞性肺疾病患者全程规范化管理中的应用现状与研究进展[J/OL]. 中华肺部疾病(电子版), 2026, 19(4): 691-695.
60
Zawada S, Faust L, Collins C, et al. Using wearable and nearable devices in telerehabilitation for COPD: a scoping review of digital endpoints in home-based programs[J]. Front Digit Health, 2026, 8: 1698019.
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