Section of Social Medicine, Department of Public Health, Copenhagen University, P.O. Box 2099, Øster Farimagsgade 5, DK-1014 Copenhagen K, Denmark.
Am J Respir Crit Care Med. 2012 Nov 15;186(10):975-81. doi: 10.1164/rccm.201207-1299OC. Epub 2012 Sep 20.
The new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations.
To investigate the abilities of this stratification to predict the clinical course of COPD.
Two similar population studies were performed in an area of Copenhagen including 6,628 individuals with COPD.
The patients were monitored for an average period of 4.3 years regarding COPD exacerbations, hospital admissions, and mortality. The percentages of individuals experiencing a COPD exacerbation during the first year of observation were 2.2% in group A, 5.8% in group B, 25.1% in group C, and 28.6% in group D. One- and 3-year mortality rates were 0.6 and 3.8%, respectively, in group A, 3.0 and 10.6% in group B, 0.7 and 8.2% in group C, and 3.4 and 20.1% in group D. Groups B and D, characterized by a higher degree of dyspnea than groups A and C, had five to eight times higher mortality from cardiovascular disease and cancer than did groups A and C.
The new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, had significantly poorer survival than group C, in spite of a higher FEV(1) level. This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.
新的全球倡议阻塞性肺病（黄金）分类慢性阻塞性肺疾病（COPD）为 A、B、C 和 D 类是基于症状，肺功能水平和加重的历史。
探讨该分层对预测 COPD 临床病程的能力。
在哥本哈根地区进行了两项类似的人群研究，包括 6628 例 COPD 患者。
平均观察 4.3 年，监测患者 COPD 加重、住院和死亡情况。在观察的第一年，A 组中有 2.2%的患者发生 COPD 加重，B 组有 5.8%，C 组有 25.1%，D 组有 28.6%。A 组的 1 年和 3 年死亡率分别为 0.6%和 3.8%，B 组为 3.0%和 10.6%，C 组为 0.7%和 8.2%，D 组为 3.4%和 20.1%。B 组和 D 组呼吸困难程度较 A 组和 C 组高，心血管疾病和癌症死亡率比 A 组和 C 组高 5 至 8 倍。
新的分层方法通过识别易发生加重的个体来很好地识别风险。令人惊讶的是，B 组（呼吸困难程度更严重）的生存率明显低于 C 组，尽管其 FEV1 水平更高。该亚组需要特别关注，因为不良预后可能由心血管疾病或癌症引起，需要进一步评估和治疗。
