St George's University of London, London.
Eur Respir J. 2013 Sep;42(3):647-54. doi: 10.1183/09031936.00125612. Epub 2012 Dec 20.
The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document recommends assessment of chronic obstructive pulmonary disease (COPD) using symptoms and future exacerbation risk, employing two score cut-points: COPD Assessment Test (CAT) score ≥ 10 or modified Medical Research Council dyspnoea scale (mMRC) grade ≥ 2. To explore the equivalence of these two symptom cut-points, the relationship between the CAT and the mMRC and St George's Respiratory Questionnaire (SGRQ), the Short-form Health Survey and the Functional Assessment of Chronic Illness Therapy Fatigue scores were retrospectively analysed using a primary care dataset. Data from 1817 patients (mean ± SD forced expiratory volume in 1 s 1.6 ± 0.6 L) showed a significant association between mMRC grades and all health status scores (ANOVA p<0.0001). mMRC grade 1 was associated with significant levels of health status impairment (SGRQ 39.4 ± 15.5 and CAT 15.7 ± 7.0); even patients with mMRC grade 0 had modestly elevated scores (SGRQ 28.5 ± 15.1 and CAT 11.7 ± 6.8). An mMRC grading ≥ 2 categorised 57.2% patients with low symptom (groups A and C) versus 17.2% with the CAT. Using the mMRC cut-point (≥ 1) resulted in similar GOLD group categorisations as the CAT (18.9%). The mMRC showed a clear relationship with health status scores; even low mMRC grades were associated with health status impairment. Cut-points of mMRC grade ≥ 1 and CAT score ≥ 10 were approximately equivalent in determining low-symptom patients. The GOLD assessment framework may require refinement.
2011 年全球慢性阻塞性肺疾病倡议（GOLD）策略文件建议使用症状和未来加重风险评估慢性阻塞性肺疾病（COPD），采用两个评分切点：COPD 评估测试（CAT）评分≥10 或改良的医学研究理事会呼吸困难量表（mMRC）等级≥2。为了探讨这两个症状切点的等效性，使用初级保健数据集回顾性分析了 CAT 与 mMRC 和圣乔治呼吸问卷（SGRQ）、简明健康调查和慢性疾病治疗疲劳功能评估量表之间的关系。来自 1817 例患者（平均±标准差 1 秒用力呼气量 1.6±0.6L）的数据显示，mMRC 等级与所有健康状况评分之间存在显著相关性（方差分析 p<0.0001）。mMRC 等级 1 与显著的健康状况受损相关（SGRQ 39.4±15.5 和 CAT 15.7±7.0）；即使 mMRC 等级 0 的患者也有适度升高的评分（SGRQ 28.5±15.1 和 CAT 11.7±6.8）。mMRC 分级≥2 将 57.2%的低症状（A 组和 C 组）患者与 17.2%的 CAT 患者进行了分类。使用 mMRC 切点（≥1）导致与 CAT 相似的 GOLD 组分类（18.9%）。mMRC 与健康状况评分之间存在明显关系；即使是低 mMRC 等级也与健康状况受损有关。mMRC 等级≥1 和 CAT 评分≥10 的切点在确定低症状患者方面大致相当。GOLD 评估框架可能需要改进。
