Hajiro T, Nishimura K, Tsukino M, Ikeda A, Koyama H, Izumi T
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Am J Respir Crit Care Med. 1998 Oct;158(4):1185-9. doi: 10.1164/ajrccm.158.4.9802091.
When dyspnea must be assessed clinically, there are three methods of assessment: the measurement of dyspnea with activities of daily living using clinical dyspnea ratings such as the modified Medical Research Council (MRC), the Baseline Dyspnea Index (BDI), and the Oxygen Cost Diagram (OCD); the measurement of dyspnea during exercise using the Borg scale; to assess the influence of dyspnea on health-related quality of life (HRQoL) using disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present cross-sectional study was to clarify relationships between dyspnea ratings and HRQoL questionnaires by applying factor analysis. One hundred sixty-one patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, HRQoL, anxiety, and depression. Factor analysis demonstrated that the MRC, BDI, OCD, and Activity of the SGRQ, and Dyspnea of the CRQ, were grouped into the same factor, and the frequency distribution histograms of these five measures showed virtually the same distribution. The Borg scale at the end of maximum exercise was found to be a different factor. The MRC, BDI, OCD, and Activity in the SGRQ, and Dyspnea in the CRQ demonstrated the same pattern of correlation with physiologic data, and they had significant relationships with FEV1 (correlation coefficients [Rs] = 0.31 to 0. 48) and maximal oxygen uptake (Rs = 0.46 to 0.60). Disease-specific HRQoL questionnaires, the SGRQ and the CRQ, which contain a specific dimension for evaluating dyspnea, may be substituted for clinical dyspnea ratings in a cross-sectional assessment. Dyspnea rating at the end of exercise may provide further information regarding dyspnea.
当必须通过临床手段评估呼吸困难时，有三种评估方法：使用改良医学研究委员会（MRC）、基线呼吸困难指数（BDI）和氧耗图（OCD）等临床呼吸困难分级，测量日常生活活动中的呼吸困难；使用博格量表测量运动期间的呼吸困难；使用圣乔治呼吸问卷（SGRQ）和慢性呼吸系统疾病问卷（CRQ）等疾病特异性问卷评估呼吸困难对健康相关生活质量（HRQoL）的影响。本横断面研究的目的是通过应用因子分析来阐明呼吸困难分级与HRQoL问卷之间的关系。161例轻至重度慢性阻塞性肺疾病（COPD）患者完成了肺功能测试、用于评估运动能力的递增式循环测力计测试、呼吸困难评估、HRQoL评估、焦虑和抑郁评估。因子分析表明，MRC、BDI、OCD以及SGRQ的活动部分和CRQ的呼吸困难部分被归为同一因子，这五项指标的频率分布直方图显示出几乎相同的分布。发现最大运动结束时的博格量表属于另一个因子。MRC、BDI、OCD以及SGRQ的活动部分和CRQ的呼吸困难部分与生理数据呈现相同的相关模式，并且它们与第一秒用力呼气容积（FEV1）（相关系数[Rs]=0.31至0.48）和最大摄氧量（Rs=0.46至0.60）具有显著相关性。包含评估呼吸困难特定维度的疾病特异性HRQoL问卷SGRQ和CRQ，在横断面评估中可替代临床呼吸困难分级。运动结束时的呼吸困难分级可能会提供有关呼吸困难的更多信息。
