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目的比较GOLD2007与GOLD2014对COPD患者病情评估的差异。方法根据2006年松江区小昆山、新浜社区卫生服务中心入户登记资料,于2008年1—2月对慢性咳嗽或气喘且年龄≥40岁、上海市户籍者按照GOLD2007的诊断标准,分批进行肺功能检查。选择符合诊断标准的患者作为随访对象。小昆山社区卫生服务中心随访时间为2008年3月—2009年2月,新浜社区卫生服务中心随访时间为2008年4月—2009年3月。分别采用GOLD2007与GOLD2014在患者随访1年后进行病情评估,并进行一致性检验。结果 711例患者中有132例符合COPD诊断,小昆山社区卫生服务中心61例,47例完成随访;新浜社区卫生服务中心71例,55例完成随访。GOLD2007评估Ⅰ期6例(5.9%),Ⅱ期21例(20.6%),Ⅲ期50例(49.0%),Ⅳ期25例(24.5%);GOLD2014评估A级23例(22.5%),B级2例(2.0%),C级46例(45.1%),D级31例(30.4%)。一致性分析结果显示,两种评估方法存在一致性(Kappa=0.412,P<0.001)。将Ⅰ+Ⅱ、Ⅲ+Ⅳ期病例数与A+B、C+D级病例数合并后,两种评估方法一致性较好(Kappa=0.948,P<0.001)。结论两种评估方法对稳定期COPD病情评估存在一致性,但依据GOLD2014,A级患者明显增加,对临床治疗存在一定的影响。
Objective To compare the differences between GOLD2007 and GOLD2014 in evaluating COPD patients’ condition. Methods According to the registration data of Xiao Kunshan and Xin Ha Community Health Service Center in Songjiang District in 2006, patients with chronic cough or asthma who were over 40 years old from January to February in 2008 were enrolled in Shanghai according to GOLD2007 diagnostic criteria Pulmonary function tests. Patients who meet the diagnostic criteria were selected as follow-up. The follow-up period of small community health service center in Kunshan was from March 2008 to February 2009, and the follow-up period of Xinhama community health service center was from April 2008 to March 2009. GOLD2007 and GOLD2014 were used to assess the patient’s condition after one year of follow-up, and the consistency test was performed. Results Of the 711 patients, 132 were diagnosed as COPD, 61 were small-scale community health service center in Kunshan, and 47 were completed follow-up. Among them, 71 were Xinchang Community Health Service Center and 55 were completed follow-up. GOLD2007 evaluated stage Ⅰ in 6 cases (5.9%), stage Ⅱ in 21 cases (20.6%), stage Ⅲ in 50 cases (49.0%), stage Ⅳ in 25 cases (24.5%), in GOLD2014 in stage A, 23 cases (22.5% Grade 2 (2.0%), Grade C 46 (45.1%), Grade D 31 (30.4%). Consistency analysis showed that there was agreement between the two assessment methods (Kappa = 0.412, P <0.001). The combination of the number of cases I + II, III + IV and the cases of A + B, C + D was better (Kappa = 0.948, P <0.001). Conclusions There is consistency between the two assessment methods in the assessment of COPD in stable stage. However, according to GOLD2014, the grade A patients obviously increase, which has certain influence on clinical treatment.