马来西亚农村地区 COPD 患者的临床表型和健康相关生活质量 - 一项横断面研究。
Clinical phenotypes and heath-related quality of life of COPD patients in a rural setting in Malaysia - a cross-sectional study.
机构信息
Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
出版信息
BMC Pulm Med. 2020 Sep 29;20(1):254. doi: 10.1186/s12890-020-01295-4.
BACKGROUND
The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients' health-related quality of life (HRQoL) according to their COPD phenotypes.
METHODS
This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c).
RESULTS
Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p < 0.001). There were significantly more patients with mMRC 2-4 among AE (68.6%) (p < 0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p < 0.001) and SGRQ-c (both p < 0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p < 0.001) scores than those with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p < 0.001), and ACO [(p = 0.003-0.016; p = < 0.001-0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001-0.040; p < 0.001) except CAT 2 and activity components of SGRQ-c.
CONCLUSIONS
The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.
背景
西班牙慢性阻塞性肺疾病（COPD）指南根据加重频率和 COPD 亚型对患者进行表型分型。在本研究中，我们根据 COPD 表型比较了患者的健康相关生活质量（HRQoL）。
方法
这是一项横断面研究，纳入了 2018 年 1 月 23 日至 2019 年 1 月 22 日期间在塞里亚分院医院和包德区医院就诊的 COPD 患者。使用改良的医学研究委员会（mMRC）、COPD 评估测试（CAT）和圣乔治呼吸问卷 COPD 量表（SGRQ-c）评估 HRQoL。
结果
185 例患者中，108 例（58.4%）为非加重者（NON-AE），51 例（27.6%）为频繁加重者（AE），其余 26 例（14.1%）为哮喘-COPD 重叠（ACO）。AE 患者中，42 例（82.4%）有慢性支气管炎，仅有 9 例（17.6%）有肺气肿。在 185 例 COPD 患者中，65.9%有生物燃料暴露，69.1%为前吸烟者或现吸烟者。COPD 表型之间 mMRC、CAT 和 SGRQ-c 评分差异均有统计学意义（p < 0.001）。AE 患者中 mMRC 2-4 评分的患者比例（68.6%）显著高于 ACO（38.5%）和 NON-AE（16.7%）（p < 0.001）。AE 患者的 CAT 总分（p = 0.003;p < 0.001）和 SGRQ-c 评分均显著高于 ACO 和 NON-AE（均 p < 0.001）。ACO 患者的 CAT 总分和 SGRQ-c 评分均显著高于 NON-AE（均 p < 0.001）。AE 患者的 CAT 各项目和 SGRQ-c 各组成部分评分均显著高于 NON-AE（均 p < 0.001），而 ACO 患者仅 CAT 1、2 和 7 的评分与 NON-AE 差异无统计学意义（p = 0.003-0.016;p = < 0.001-0.005）。ACO 患者的 CAT 各项目和 SGRQ-c 各组成部分评分均显著高于 NON-AE（均 p < 0.001），仅 CAT 2 和 SGRQ-c 活动成分评分与 NON-AE 差异无统计学意义（p = < 0.001-0.040）。
结论
不同 COPD 表型患者的 HRQoL 存在显著差异。AE 患者的 HRQoL 最差，其次是 ACO 和 NON-AE。本研究支持根据加重频率和 COPD 亚型对 COPD 患者进行表型分型。应根据这两个因素对 COPD 进行个体化治疗。
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