Hernández Marcos, García Gabriel, Falco Jimena, García Agustín R, Martín Vanina, Ibarrola Manuel, Quadrelli Silvia
Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina.
Int J Chron Obstruct Pulmon Dis. 2018 Jan 17;13:351-356. doi: 10.2147/COPD.S112551. eCollection 2018.
The objective of this study was to examine how COPD patients were classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometry-based severity system and the distribution of COPD severity using the new GOLD 2011 assessment framework.
This was an observational, retrospective cohort study conducted in a single tertiary center on a prospective database, which aimed to evaluate the prevalence, incidence, severity, and comorbidities of COPD. Inclusion criteria were age ≥40 years and COPD diagnosis according to GOLD 2007 classification. Clinical factors were compared between the categories in GOLD 2007 and 2011 groups by using the test for categorical data and the analysis of variance for continuous data.
In total, 420 COPD patients were included in the analysis. The distribution of patients into GOLD 2007 categories was as follows: 6.4% (n=27) of them were classified into subgroup I, 42.1% (n=177) into subgroup II, 37.9% (n=159) into subgroup III, and 13.6% (n=57) into subgroup IV. The distribution of patients into GOLD 2011 categories was as follows: 16.4% (n=69) of them were classified into subgroup A (low risk and fewer symptoms), 32.1% (n=135) into subgroup B (low risk and more symptoms), 21.6% (n=91) into subgroup C (high risk and fewer symptoms), and 29.7% (n=125) into subgroup D (high risk and more symptoms). After the application of the new GOLD 2011 (modified Medical Research Council [mMRC] system), 22% (n=94) of patients were upgraded to a higher level than their spirometry level, and 16.2% (n=68) of them were downgraded in their severity category, meaning that almost 40% of patients changed their severity assessment category. In total, 22% of patients in stage I were allocated to group B, and 35% of patients in stage IV were allocated to group C. Patients in stage III were the most frequently upgraded to a higher risk group (D), taking into account mMRC and exacerbation history.
Classifying patients using the new GOLD 2011 criteria reallocated a relevant proportion of patients to a different risk category and identified larger proportions of patients in the mildest and more severe groups compared with GOLD 2007 classification.
本研究的目的是探讨慢性阻塞性肺疾病全球倡议组织（GOLD）基于肺量计的严重程度系统如何对慢性阻塞性肺疾病（COPD）患者进行分类，以及使用新的GOLD 2011评估框架时COPD严重程度的分布情况。
这是一项在单一三级中心对前瞻性数据库进行的观察性、回顾性队列研究，旨在评估COPD的患病率、发病率、严重程度和合并症。纳入标准为年龄≥40岁且根据GOLD 2007分类诊断为COPD。通过使用分类数据的检验和连续数据的方差分析，比较GOLD 2007组和2011组各分类之间的临床因素。
总共420例COPD患者纳入分析。患者在GOLD 2007分类中的分布如下：6.4%（n = 27）被分类为I亚组，42.1%（n = 177）为II亚组，37.9%（n = 159）为III亚组，13.6%（n = 57）为IV亚组。患者在GOLD 2011分类中的分布如下：16.4%（n = 69）被分类为A亚组（低风险且症状较少），32.1%（n = 135）为B亚组（低风险且症状较多），21.6%（n = 91）为C亚组（高风险且症状较少），29.7%（n = 125）为D亚组（高风险且症状较多）。应用新的GOLD 2011（改良医学研究委员会[mMRC]系统）后，22%（n = 94）的患者被升级到比其肺量计水平更高的级别，16.2%（n = 68）的患者严重程度类别被降级，这意味着近40%的患者改变了其严重程度评估类别。总共22%的I期患者被分配到B组；IV期患者中35%被分配到C组。考虑到mMRC和加重病史，III期患者最常被升级到更高风险组（D组）。
与GOLD 2007分类相比，使用新的GOLD 2011标准对患者进行分类会将相当比例的患者重新分配到不同的风险类别，并在最轻度和最严重组中识别出更大比例的患者。
