慢性阻塞性肺疾病（COPD）患者改良医学研究委员会呼吸困难评分与COPD评估测试评分之间的差异

Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD.

作者信息

Rhee Chin Kook, Kim Jin Woo, Hwang Yong Il, Lee Jin Hwa, Jung Ki-Suck, Lee Myung Goo, Yoo Kwang Ha, Lee Sang Haak, Shin Kyeong-Cheol, Yoon Hyoung Kyu

机构信息

Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea.

出版信息

Int J Chron Obstruct Pulmon Dis. 2015 Aug 12;10:1623-31. doi: 10.2147/COPD.S87147. eCollection 2015.

BACKGROUND AND OBJECTIVE

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, either a modified Medical Research Council (mMRC) dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score of ≥10 is considered to represent COPD patients who are more symptomatic. We aimed to identify the ideal CAT score that exhibits minimal discrepancy with the mMRC score.

METHODS

A receiver operating characteristic curve of the CAT score was generated for an mMRC scores of 1 and 2. A concordance analysis was applied to quantify the association between the frequencies of patients categorized into GOLD groups A-D using symptom cutoff points. A κ-coefficient was calculated.

RESULTS

For an mMRC score of 2, a CAT score of 15 showed the maximum value of Youden's index with a sensitivity and specificity of 0.70 and 0.66, respectively (area under the receiver operating characteristic curve [AUC] 0.74; 95% confidence interval [CI], 0.70-0.77). For an mMRC score of 1, a CAT score of 10 showed the maximum value of Youden's index with a sensitivity and specificity of 0.77 and 0.65, respectively (AUC 0.77; 95% CI, 0.72-0.83). The κ value for concordance was highest between an mMRC score of 1 and a CAT score of 10 (0.66), followed by an mMRC score of 2 and a CAT score of 15 (0.56), an mMRC score of 2 and a CAT score of 10 (0.47), and an mMRC score of 1 and a CAT score of 15 (0.43).

CONCLUSION

A CAT score of 10 was most concordant with an mMRC score of 1 when classifying patients with COPD into GOLD groups A-D. However, a discrepancy remains between the CAT and mMRC scoring systems.

背景与目的

根据慢性阻塞性肺疾病全球倡议（GOLD）指南，改良医学研究委员会（mMRC）呼吸困难评分≥2或慢性阻塞性肺疾病（COPD）评估测试（CAT）评分≥10被认为代表症状更明显的COPD患者。我们旨在确定与mMRC评分差异最小的理想CAT评分。

方法

针对mMRC评分为1和2的情况生成CAT评分的受试者工作特征曲线。应用一致性分析来量化使用症状截断点分类为GOLD A - D组的患者频率之间的关联。计算κ系数。

结果

对于mMRC评分为2的情况，CAT评分为15时约登指数达到最大值，敏感性和特异性分别为0.70和0.66（受试者工作特征曲线下面积[AUC]为0.74；95%置信区间[CI]，0.70 - 0.77）。对于mMRC评分为1的情况，CAT评分为10时约登指数达到最大值，敏感性和特异性分别为0.77和0.65（AUC为0.77；95% CI，0.72 - 0.83）。一致性的κ值在mMRC评分为1且CAT评分为10时最高（0.66），其次是mMRC评分为2且CAT评分为15时（0.56）、mMRC评分为2且CAT评分为10时（0.47）以及mMRC评分为1且CAT评分为15时（0.43）。