就713例COPD患者资料对原中美COPD分级标准的比较与评价

目的：比较评价慢性阻塞性肺疾病防治全球倡议（GOLD）之前中华呼吸学会（CRA）和美国胸科学会（ATS）及GOLD关于慢性阻塞性肺疾病（COPD）的分级标准.方法：对713例CODP患者的肺功能测定结果分别按1997年CRA和1995年ATS的分级标准进行分级并比较,同时对FEV1%预计值与PEF%、Vmax75%、Vmax50%、Vmax25%分别进行相关分析.结果：反映气流受限及肺功能受损程度的FEV1%预计值及FEV1/FVC、FVC%、PEF%、Vmax75%、Vmax50%、Vmax25%、MVV%、VC%等指标CRA和ATS的分级标准比较差异存在显著性意义（P〈0.05）.按CRA分级标准,713例中COPD重度患者所占比例最高,达55.9%;按ATS分级标准则是轻度患者所占比例最高,达54.1%.相关分析显示,按CRA分级标准,轻度COPD患者的FEV1%预计值与PEF%和Vmax75%无明显相关性,但与Vmax50%、Vmax25%明显相关;中、重度及按ATS分级标准划定的轻、中、重度患者FEV1%预计值与PEF%、Vmax75%、Vmax50%、Vmax25%均呈明显正相关关系.结论：1997年CRA的COPD分级标准较1995年ATS标准以及以ATS标准为蓝本的GOLD标准更能客观、准确地反映COPD患者的肺部病变及肺功能受损程度、工作劳动能力及生活自理情况.

Comparing and Evaluating the two Diagnostic Criteria of Severity of COPD Adopted by China and America Based on Data From 713 COPD Patients

Objective: To compare and evaluate the diagnostic criteria of severity of chronic obstructive pulmonary disease(COPD) adopted by Global Initiative for chronic obstructive lung disease(GOLD) and the old criteria adopted by Chinese Respiratory Academy(CRA) and American Thoracic Society(ATS).Methods: The data of pulmonary function of 713 COPD patients were graded and compared based on different criteria from CRA in 1997 and ATS in 1995,and the correlation analysis was made respectively between the predictive value of FEV_1% and PEF%,FEV_1% and Vmax_(75)%,Vmax_(50)% or Vmax_(25)%.Results: There was statistically significant difference(P<0.05) in the indexes such as the predictive value of FEV_1% that reflect airflow limitation and the degree of injury in pulmonary function,FEV_1/FVC,FVC%,PEF%,Vmax_(75)%,Vmax_(50)%,Vmax_(25)%,MVV% and VC% between CRA and ATS.If using criteria of CRA in 1997,the moderate and severe COPD in 713 patients occupied the maximum proportion of 55.9%,but if using criteria of ATS in 1995,the mild COPD occupied the maximum proportion of 54.1%.Correlation analysis appeared there was no significant correlation between the predictive value of FEV_1% and PEF% or Vmax_(75)% in mild COPD patients by criteria of CRA in 1997,but there was significant correlation between the predictive value of FEV_1% and Vmax_(50)% or Vmax_(25)%.There was significant positive correlation between the predictive value of FEV_1% and PEF%,Vmax_(75)%,Vmax_(50)% or Vmax_(25)% both in moderate/severe COPD by criteria of CRA in 1997 and in mild/ moderate/severe COPD by criteria of ATS in 1995.Conclusion: Compared with the diagnostic criteria of severity of COPD adopted by ATS in 1995 and the GOLD in which the original foundation was the criteria by ATS,the criteria by CRA in 1997 was more objective and accurate to reflect the degree of injury of lung disease and pulmonary function,the ability of working,laboring and self-care of life.