Jones P W, Agusti A G N
Respiratory Medicine, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, UK, and Serviei de Pneumologia, Hospital Universitari Son Dureta, Fundació Caubet-Cimera, Palma de Mallorca, Spain.
Eur Respir J. 2006 Apr;27(4):822-32. doi: 10.1183/09031936.06.00145104.
The clinical presentation of chronic obstructive pulmonary disease (COPD) is highly variable, reflecting the interaction of a complex range of pathological changes including both pulmonary and systemic effects. The consequences of COPD experienced by the patient (i.e. its outcomes) include: symptoms, weight loss, exercise intolerance, exacerbations, health-related quality of life, health resource use and death. No single measure can reflect the variety of pathological effects or adequately describe the nature or severity of COPD. Currently, there are few validated markers for assessing COPD and evaluating the effectiveness of treatment. The forced expiratory volume in one second has been used as a global marker of COPD, but it does not fully reflect the burden of COPD on patients. New markers are needed to better characterise the full clinical spectrum of the disease and to guide the development and assessment of new and more effective therapies. This article considers the distinction between outcomes and markers, the various ways in which markers are used and the need for new markers in the management of chronic obstructive pulmonary disease. The process of marker selection and validation is reviewed and potential new biological, physiological and symptomatic markers for chronic obstructive pulmonary disease are assessed.
慢性阻塞性肺疾病（COPD）的临床表现高度多变，反映了一系列复杂病理变化的相互作用，包括肺部和全身影响。患者所经历的COPD后果（即其结局）包括：症状、体重减轻、运动不耐受、急性加重、健康相关生活质量、卫生资源利用和死亡。没有单一指标能够反映各种病理效应，也无法充分描述COPD的性质或严重程度。目前，用于评估COPD和评价治疗效果的经过验证的指标很少。一秒用力呼气容积一直被用作COPD的整体指标，但它并不能完全反映COPD给患者带来的负担。需要新的指标来更好地描述该疾病的完整临床谱，并指导新的更有效治疗方法的研发和评估。本文探讨了结局与指标之间的区别、指标的各种使用方式以及COPD管理中对新指标的需求。对指标的选择和验证过程进行了综述，并评估了慢性阻塞性肺疾病潜在的新生物、生理和症状性指标。
