慢性阻塞性肺疾病新指南对临床患者分类的应用价值

doi:10.6040/j.issn.1671-7554.0.2015.483

摘要/Abstract

摘要： 目的探讨慢性阻塞性肺疾病(COPD)2013年西班牙新指南新临床分型的临床意义。方法回顾收集2009年1月至2014年12月安徽医科大学附属安庆市立医院呼吸内科收治的确诊COPD患者640例的临床资料,按照2013年西班牙指南的分型方法将其分为A、B、C、D四组,对各组的肺功能和血气分析指标、合并症的发生率及抗生素、激素的使用量进行分析比较。结果 C组和D组的肺功能指标第一秒用力呼气容积(FEV1)、第一秒用力呼气容积/用力肺活量(FEV1%)明显低于A组和B组(P<0.05);糖尿病、高血压在各组中患病比例差异无统计学意义(P>0.05);而冠心病、心律失常、心力衰竭在C、D组比例明显高于A组和B组(P<0.05),其在D组中比例高于C组(P<0.05)。A、B组抗生素的使用时间明显低于C、D组(P<0.05),D组的抗生素使用时间显著高于C组(P<0.05)。B组激素使用量高于其他组(P<0.05),C、D组的激素使用量高于A组(P<0.05)。D组的住院时间在各组中最高,而A组的住院时间最短。D组在机械通气、机械通气时间、病死率上明显高于其他组(P<0.05)。结论新指南的临床分型有重要指导作用,需要深入研究来验证其临床价值。

关键词: 慢性阻塞性肺疾病, 临床分型, 西班牙新指南

Abstract: Objective To investigate the clinical significance of the clinical classification of the Spanish new clinical guidelines in chronic obstructive pulmonary disease(COPD)in 2013. Methods A total of 640 cases who had been diagnosed as COPD and hospitalized in the department of respiratory medicine of Anqing Municipal Hospital Affilicated to Anhui Medical University were collected from January 2009 to December 2014. According to the typing method of Spanish guidelines in 2013, the 640 cases were divided into four groups named A, B, C and D respectively. The pulmonary function, index of analysis of blood gas, morbidity of complication, the usage of antibiotics and hormone of each group were analyzed and compared. Results Pulmonary function forced expiratory volume in one second(FEV1)and forced expiratory volume in one second/forced vital capacity(FEV1%)in groups C and D were significantly lower than those in groups A and B(P<0.05). There was no significant difference in each group about the morbidity of diabetes and hypertension(P>0.05), while the incidence of coronary heart disease, arrhythmia and heart failure in groups C and D were significantly higher than those in groups A and B(P<0.05), and in group D higher than in group C(P<0.05). The usage time of antibiotics in groups A and B were significantly lower than that in groups C and D(P<0.05), and in group D was obviously higher than in group C(P<0.05). The use amount of hormone in group B was higher than that in groups A, C and D(P<0.05), and in groups C and D higher than in group A(P<0.05). In all groups, hospitalization time in group D was longest and shortest in group A. Usage of mechanical 山东大学学报 (医学版)54卷3期 -潘青,等.慢性阻塞性肺疾病新指南对临床患者分类的应用价值 \=-ventilation, mechanical ventilation time and mortality rate in group D was significantly higher than that in other groups(P<0.05). Conclusion The clinical classification of the new guidelines has important guiding role, but it needs further studies to verify its clinical value.

Key words: Spanish new clinical guidelines, Chronic obstructive pulmonary disease, Clinical classification

中图分类号:

R563

潘青,吕志芳. 慢性阻塞性肺疾病新指南对临床患者分类的应用价值[J]. 山东大学学报（医学版）, 2016, 54(3): 63-67.

PAN Qing, LÜ Zhifang. Clinical application value of the new guide for patients with chronic obstructive pulmonary disease[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(3): 63-67.

参考文献

[1] Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary[J]. Am J Respir Crit Care Med, 2013, 187(4): 347-365.
[2] Davis KJ, Landis SH, Oh YM, et al. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries[J]. Int J Chron Obstruct Pulmon Dis, 2014, 10: 39-55.
[3] 金哲,王广发. 慢性阻塞性肺疾病全球倡议(2014更新版)解读[J].中国医学前沿杂志(电子版), 2014, 6(2): 94-97.
[4] 李仰瑞,熊伟,赵伟,等. 心血管合并症对老年慢性阻塞性肺疾病患者急性加重及预后的影响[J].老年医学与保健, 2014, 20(6): 400-405. LI Yangrui, XIONG Wei, ZHAO Wei, et al. The influence of cardiovascular complications on acute exacerbation and prognosis of chronic obstructive pulmonary disease in elderly patients[J]. Geriatr Health Care, 2014, 20(6): 400-405.
[5] Calverley PM, Anderson JA, Celli B, et al. Cardiovascular events in patients with COPD: TORCH study results[J]. Thorax, 2010, 65(8):719-725.
[6] 孙奥松,单守勤. CT冠状动脉成像与钙化积分结合评价冠心病的价值[J].实用放射学杂志, 2014, 30(3): 425-429. SUN Aosong, SHAN Shouqin. The value of hybrid CT coronary angiography and calcium score to assess coronary artery disease[J]. J Pract Radiol, 2014, 30(3): 425-429.
[7] Beran D, Zar HJ, Perrin C, et al. Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries[J]. Lancet Respir Med, 2015, 3(2): 159-170.
[8] Miravitlles M, Soler-Cataluña JJ, Calle M, et al. A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD guidelines(GesEPOC)[J]. Prim Care Respir J, 2013, 22(1): 117-121.
[9] Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD[J]. Am J Respir Crit Care Med, 2010, 182(5):598-604.
[10] Soriano JB, Davis KJ, Coleman B, et al. The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom[J]. Chest, 2003, 124(2): 474-481.
[11] O’Hare PE, Ayres JF, O’Rourke RL, et al. Coronary artery calcification on computed tomography correlates with mortality in chronic obstructive pulmonary disease[J]. J Comput Assist Tomogr, 2014, 38(5): 753-759.
[12] Williams MC, Murchison JT, Edwards LD, et al. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality[J]. Thorax, 2014, 69(8): 718-723.
[13] Etminan M, Jafari S, Carleton B, et al. Beta-blocker use and COPD mortality: a systematic review and meta-analysis[J]. BMC Pulm Med, 2012, 12: 48.
[14] Puente-Maestu L, Calle M, Ortega-González A, et al. Multicentric study on the beta-blocker use and relation with exacerbations in COPD[J]. Respir Med, 2014, 108(5): 737-744.
[15] Kargin F, Takir HB, Salturk C, et al. The safety of beta-blocker use in chronic obstructive pulmonary disease patients with respiratory failure in the intensive care unit[J]. Multidiscip Respir Med, 2014, 9(1): 8.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed