Grzelewska-Rzymowska Iwona, Patora-Mikołajczyk Joanna, Górski Paweł
Department of Pneumonology and Allergology, Medical University of Lodz, Poland.
Pneumonol Alergol Pol. 2014;82(5):415-21. doi: 10.5603/PiAP.2014.0054.
The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry.
Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD was defined according to GOLD fixed cut-off criterion FEV1/FVC < 0.70. In all patients postbronchodilator spirometry was performed. Categories were defined with the mMRC dyspnoea scale and CAT scale. COPD exacerbations in the previous year and lung function were evaluated. Statistical comparisons were done using t-student test.
315 COPD patients, 99 (31.4%) women and 216 (68.6%) men, were examined. Mean pack-years in the whole group was 47.1 ± 17.8. In women this figure was less than in men, 43.7 ± 19.2 vs 49.5 ± 16.5 (p > 0.05), respectively. At study entry, 144 subjects (45.7%) were current smokers, and the majority of them (n-87, 60.4%) belonged to category D - 26/66 (54.5%) women and 51/102 (50%) men. Based on spirometry alone, the patients were classified as moderate COPD 144 (45.71%), severe - 154 (48.89%), and very severe 17 (5.4%). According to the 2011 GOLD report stratification, 60 patients (19.04%) were graded as category A, 63 (20%) as category B, 24 (7.62%) as category C, and 168 (53.33%) as category D, although 21 (12.5% of them) were in category B, but the number of exacerbations classified them as category D.
The COPD population is heterogeneous in reference to the symptoms, value of FEV1, and susceptibility to exacerbations. Clinical symptoms assessed using validated questionnaires characterized COPD patients better than the value of spirometric parameters (which are necessary for diagnosis of this disease). Some patients were difficult to classify, especially those belonging to category C.
作者旨在比较基于新的慢性阻塞性肺疾病（COPD）全球倡议（GOLD）分级与仅基于肺量计测定的分期的COPD分布情况。
符合条件的患者平均年龄为64.8岁，吸烟史至少10包年。COPD根据GOLD固定截断标准FEV1/FVC<0.70进行定义。对所有患者进行支气管扩张剂后肺量计测定。使用改良英国医学研究委员会（mMRC）呼吸困难量表和COPD评估测试（CAT）量表定义类别。评估前一年的COPD急性加重情况和肺功能。采用t检验进行统计学比较。
共检查了315例COPD患者，其中女性99例（31.4%），男性216例（68.6%）。全组平均吸烟包年数为47.1±17.8。女性这一数字低于男性，分别为43.7±19.2和49.5±16.5（p>0.05）。在研究开始时，144名受试者（45.7%）为当前吸烟者，其中大多数（n = 87，60.4%）属于D组——女性26/66（54.5%），男性51/102（50%）。仅基于肺量计测定，患者被分类为中度COPD 144例（45.71%）、重度154例（48.89%）和极重度17例（5.4%）。根据2011年GOLD报告分层，60例患者（19.04%）被分级为A组，63例（20%）为B组，24例（7.62%）为C组，168例（53.33%）为D组，尽管其中21例（占B组的12.5%）处于B组，但急性加重次数将他们归类为D组。
COPD人群在症状、FEV1值和急性加重易感性方面存在异质性。使用经过验证的问卷评估的临床症状比肺量计参数值（该疾病诊断所必需）能更好地表征COPD患者。一些患者难以分类，尤其是那些属于C组的患者。
