上海市嘉定区社区慢性阻塞性肺疾病防治状况调查

目的探讨上海市嘉定区2个社区卫生服务中心慢性阻塞性肺疾病(CODP)高危人群的患病情况并分析其危险因素。方法于2011年5~12月对上海市嘉定区真新及华亭2个社区卫生服务中心服务区域内常住居民中的高危人群进行肺功能检测,同时进行问卷调查。以肺功能检测结果作为COPD的诊断依据,分析COPD患者肺功能、男女比例、吸烟及治疗情况等。结果共有2008例有效对象纳入本调查,平均年龄(66.2±2.5)岁,高危人群COPD患病率达8.2%(165/2008),男性患病率为10.5%(100/956),女性为6.2%(65/1052)。其中无症状COPD患者65例,既往被诊断为慢性支气管炎、肺气肿80例,诊断为COPD者5例,80例患者未被诊断出慢性支气管炎、肺气肿或COPD,COPD患者的漏诊率为48.5%(80/165)。1年中COPD患者服用过茶碱类药物80例(48.5%),口服长效用β2受体激动剂23例(13.9%),吸入支气管扩张剂19例(11.5%),吸入糖皮质激素的仅3例(1.8%)。男有40例COPD(占24.2%)患者服用过含糖皮质激素的外地邮购药物。在73例Ⅲ、Ⅳ级COPD患者中,家庭氧疗的仅为2例。多因素分析显示,吸烟及厨房无通风设备是COPD的危险因素。结论作为诊断标准的肺功能检测在社区医院开展的不够,社区COPD患者诊断治疗严重不足,对于年龄40岁,有吸烟史,厨房无通风设备等高危因素的人群早期行肺功能检查是很有必要的。

A community survey of chronic obstructive pulmonary disease in Jiading district of Shanghai

Objective To investigate the prevalence and risk factors of chronic obstructive pulmonary disease （COPD） in two community of Jiading Districts of Shanghai. Methods Pulmonary function testing and a questionnaire survey were conducted in people with high risk of COPD from May 2011 to December 2011 on the Community Health Center of Jiading District. The proportion of COPD, smoking condition, treatment and risk factors were analyzed. Results A total of 2008 cases were included in this survey. The average age was 66. 2±2. 5 years, and the prevalence rate in the high risk population of COPD was 8.2% （ 165/2008 ） , and the prevalence was 10. 5% （ 100/956 ） in male and 6. 2% （ 65/ 1052） in the female. Eighty cases were diagnosed as chronic bronchitis, emphysema, 5 cases diagnosed as COPD. Eighty patients had not been diagnosed as chronic bronchitis, emphysema, or COPD, out of which 65 cases were asymptomatic. The misdiagnosis rate of COPD was 48.5% （80/100）. In 1 year, 80 cases were given theophylline drugs （80/165, 48. 5%） , 23 cases given oral long-term use beta agonists （13.9%） , and 19 cases only inhaled bronchodilator （11.5%） and 3 cases （1.8%） inhaled glucocorticoids. Forty patients with COPD （ 24. 2% ） had taken mail-order drugs containing glucocorticoids. Of all the 73 patients with grade Ⅲ or Ⅳ, only 2 eases were treated with family oxygen therapy. Logistic analysis indicated that smoking and kitchen without ventilation equipment were the risk factors of COPD. Conclusions The detection of lung function in community hospitals and the treatment for COPD is insufficient. Early detection of lungfunction is necessary for people aged go years old and over, or with a history of smoking, kitchen without ventilation equipment.