Huijsmans Rosalie J, de Haan Arnold, ten Hacken Nick N H T, Straver Renata V M, van't Hul Alex J
Institute for Fundamental and Clinical Human Movement Sciences, Free University, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
Respir Med. 2008 Jan;102(1):162-71. doi: 10.1016/j.rmed.2007.07.008. Epub 2007 Sep 18.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has introduced a four-stage classification of chronic obstructive pulmonary disease (COPD) severity. The present study investigated the discriminatory capacity of the GOLD classification for health status outcomes in patients with COPD. An additional analysis was performed to investigate the discriminatory capacity of a multidimensional staging system, i.e. the Body-Mass Index, Degree of Airflow Obstruction and Dyspnea, and Exercise Capacity Index (BODE index) for the outcome of quality of life. Retrospective analysis was performed on 253 COPD patients (30% stage II, 48% stage III, 22% stage IV), referred for outpatient pulmonary rehabilitation. Pulmonary function, exercise capacity, dyspnoea and quality of life were evaluated. Analyses of variance were used to detect differences between GOLD stages and BODE index quartiles, and scatterplots of individual responses were produced as well. The GOLD classification discriminated between stages for pulmonary function (p<0.001), exercise capacity (p<0.001), dyspnoea (p<0.001) and the activities section (p=0.001) of the St. George Respiratory Questionnaire (SGRQ). The BODE index discriminated between quartiles for the activities section (p<0.001), impacts section (p=0.04) and the total score (p=0.01) of the SGRQ. Scatterplots revealed marked inter-individual variation within each GOLD stage or BODE index quartile, and considerable overlap between stages for all health status outcomes. These findings show that the GOLD classification indeed can be used to discern groups of COPD patients, but due to large inter-individual variability it does not seem adequate as a basis for individual management plans in rehabilitation. The BODE index appeared to discriminate slightly better for quality of life, however, it still leaves a significant part of the variance unexplained.
慢性阻塞性肺疾病全球倡议组织(GOLD)推出了慢性阻塞性肺疾病(COPD)严重程度的四阶段分类法。本研究调查了GOLD分类法对COPD患者健康状况结果的区分能力。还进行了一项额外分析,以研究多维分期系统,即体重指数、气流阻塞程度、呼吸困难和运动能力指数(BODE指数)对生活质量结果的区分能力。对253例因门诊肺康复而转诊的COPD患者进行了回顾性分析。评估了肺功能、运动能力、呼吸困难和生活质量。采用方差分析检测GOLD分期与BODE指数四分位数之间的差异,并绘制了个体反应的散点图。GOLD分类法在肺功能(p<0.001)、运动能力(p<0.001)、呼吸困难(p<0.001)以及圣乔治呼吸问卷(SGRQ)的活动部分(p=0.001)的各阶段之间存在差异。BODE指数在SGRQ的活动部分(p<0.001)、影响部分(p=0.04)和总分(p=0.01)的四分位数之间存在差异。散点图显示,在每个GOLD分期或BODE指数四分位数内个体间存在显著差异,并且在所有健康状况结果的各阶段之间存在相当大的重叠。这些发现表明,GOLD分类法确实可用于区分COPD患者组,但由于个体间差异较大,它似乎不足以作为康复中个体管理计划的基础。然而,BODE指数对生活质量的区分似乎稍好一些,不过,仍有很大一部分变异无法解释。
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