Bestall J C, Paul E A, Garrod R, Garnham R, Jones P W, Wedzicha J A
Division of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE, UK.
Thorax. 1999 Jul;54(7):581-6. doi: 10.1136/thx.54.7.581.
Methods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study examined the validity of the Medical Research Council (MRC) dyspnoea scale for this purpose.
One hundred patients with COPD were recruited from an outpatient pulmonary rehabilitation programme. Assessments included the MRC dyspnoea scale, spirometric tests, blood gas tensions, a shuttle walking test, and Borg scores for perceived breathlessness before and after exercise. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). The Nottingham Extended Activities of Daily Living (EADL) score and Hospital Anxiety and Depression (HAD) score were also measured.
Of the patients studied, 32 were classified as having MRC grade 3 dyspnoea, 34 MRC grade 4 dyspnoea, and 34 MRC grade 5 dyspnoea. Patients with MRC grades 1 and 2 dyspnoea were not included in the study. There was a significant association between MRC grade and shuttle distance, SGRQ and CRQ scores, mood state and EADL. Forced expiratory volume in one second (FEV1) was not associated with MRC grade. Multiple logistic regression showed that the determinants of disability appeared to vary with the level of disability. Between MRC grades 3 and 4 the significant covariates were exercise performance, SGRQ and depression score, whilst between grades 4 and 5 exercise performance and age were the major determinants.
The MRC dyspnoea scale is a simple and valid method of categorising patients with COPD in terms of their disability that could be used to complement FEV1 in the classification of COPD severity.
慢性阻塞性肺疾病（COPD）的分类方法很大程度上依赖于肺功能测定，但残疾程度与肺功能测量的相关性较弱。随着肺康复治疗的使用增加，人们发现需要一种简单且标准化的方法来对COPD患者的残疾程度进行分类。本研究旨在检验医学研究委员会（MRC）呼吸困难量表在此方面的有效性。
从门诊肺康复项目中招募了100例COPD患者。评估内容包括MRC呼吸困难量表、肺功能测试、血气张力、往返步行试验以及运动前后的Borg呼吸困难评分。使用圣乔治呼吸问卷（SGRQ）和慢性呼吸问卷（CRQ）评估健康状况。还测量了诺丁汉扩展日常生活活动（EADL）评分和医院焦虑抑郁（HAD）评分。
在研究的患者中，32例被分类为MRC 3级呼吸困难，34例为MRC 4级呼吸困难，34例为MRC 5级呼吸困难。MRC 1级和2级呼吸困难的患者未纳入本研究。MRC分级与往返距离、SGRQ和CRQ评分、情绪状态及EADL之间存在显著关联。一秒用力呼气容积（FEV1）与MRC分级无关。多元逻辑回归显示，残疾的决定因素似乎因残疾程度而异。在MRC 3级和4级之间，显著的协变量是运动表现、SGRQ和抑郁评分，而在4级和5级之间，运动表现和年龄是主要决定因素。
MRC呼吸困难量表是一种简单有效的对COPD患者残疾程度进行分类的方法，可用于补充FEV1以对COPD严重程度进行分类。
