北京市社区高危人群慢性阻塞性肺疾病诊断与疾病分类状况调查

目的了解北京市社区高危人群慢性阻塞性肺疾病（简称慢阻肺）的诊断和病情评估状况。方法自2011年1月至2012年12月对北京市东城区6个社区40岁以上具有吸烟史或慢性支气管炎病史的部分高危人群进行问卷调查和肺功能检查。对确诊慢阻肺的患者进行呼吸困难评分，并记录最近1年内急性加重次数。根据2011年慢阻肺全球防治创议（GOLD）病情评估的分类标准进行疾病分组。数据采用SPSS19．0软件进行统计学分析。结果共筛查932例，男689例（73．9％），年龄（60．8±12．5）岁；女243例（26．1％），年龄（59．8±12．1）岁。确诊慢阻肺203例，患病率21．8％；其中仅15．3％的患者曾诊断过慢阻肺。根据2011年GOLD分类标准，A组、B组、C组和D组的人数和比例分别为96例（47．2％）、38例（18．7％）、56例（27．5％）和13例（6．4％）。其中c1亚组（FEV1〈50％预计值且前1年急性加重次数〈2次）例数占C组患者的比例为71．4％。结论对具有明确慢阻肺易患因素及早期症状的社区高危人群开展筛查工作可提高慢阻肺早期诊断率。多数社区患者因症状轻而延误就诊，其中GOLD分组中C组患者比例较高，提示对高危人群进行筛查可能对慢阻肺防治具有积极作用。

The Diagnosis and Classification of Chronic Obstructive Pulmonary Disease in High Risk Populations Living in Metropolitan Communities of Beijing

Objective To investigate the diagnosis and classification of chronic obstructive pulmonary disease （COPD） in high risk populations living in metropolitan communities of Beijing. Methods During January 2011 to December 2012, a cross-sectional survey including questionnaires and pulmonary function tests were performed in high risk populations of COPD （ aged ≥40 years with a history of smoking or chronic bronchitis） at 6 communities in Dongcheng District of Beijing. For those confirmed to have COPD, the dyspnea was rated by the modified Medical Research Council Dyspnea Scale （mMRC）, and the frequency of acute exacerbations in the last year was recorded. The patients were classified by the Global Initiative for Chronic Obstructive Lung Disease （GOLD 2011 ） classification criteria. Results A total of 932 individuals,inCluding 689 males （73.9% ,aged 60. 8 ± 12. 5 years） and 243 females（26. 1% ,aged 59. 8 ± 12. 1 years） ,who had risk factors of COPD were included in the screening. COPD was confirmed in 203 patients,with the prevalence of 21.8%, and among whom only 31 cases （ 15.3% ） had been diagnosed as COPD in the past. According to the revised GOLD classification in 2011,96 （47.2%）, 38 （ 18.7% ）, 56 （27. 5 % ）, and 13 （6. 4% ） patients were classified into group A, B, C and D, respectively. The proportion of subgroup C1 （FEV1% pred 〈 50% and the number of exacerbation in the last year 〈 2） in group C was 71.4% （40/56）. Conclusions In the metropolitan communities of Beijing, screening the population with predisposing factors can increase the early diagnosis of COPD, which is often delayed by the lack of significant symptoms. The high proportion of patients in group C in this population implies that disease screening in high risk populations may be helpful for the prevention and treatment of COPD.