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学科主题: 呼吸内科学
题名:
新病情评估方法对慢性阻塞性肺疾病稳定期患者药物治疗方案的影响
其他题名: Present status of medical treatment for patients with chronic obstructive pulmonary disease based upon different severity classifications
作者: 孙丽娜; 陈亚红; 常春; 康健; 蔡柏蔷; 周新; 刘政; 陈萍; 孙德俊
关键词: 肺疾病,慢性阻塞性 ; 临床方案 ; 病情评估分组 ; 指南 ; Pulmonary disease,chronic obstructive ; Clinical protocols ; Disease severity classification ; Guideline
刊名: 中华医学杂志
发表日期: 2015
DOI: 10.3760/cma.j.issn.0376-2491.2015.08.003
卷: 95, 期:8, 页:570-576
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 调查我国慢性阻塞性肺疾病(慢阻肺)患者的药物治疗情况,分别与慢阻肺诊治指南2007版、2013版推荐首选治疗方案进行比较,探究病情评估分组标准的更新对药物治疗方案的影响.方法 回顾性调查2007年9月-2008年12月全国11家三级医院门诊连续就诊的慢阻肺患者的临床资料,分别根据慢阻肺诊治指南2007、2013年修订版将患者分为GOLD Ⅰ~Ⅳ级和A~D组,比较药物治疗现状与2个指南推荐方案的差距,探究指南的更新对稳定期治疗方案的影响.结果 共纳入患者749例,应用药物治疗的患者占79.2% (593/749).其中按2007版指南分组:GOLD Ⅰ级34例(4.5%),Ⅱ级211例(28.2%),Ⅲ级309例(41.3%),Ⅳ级195例(26.0%);Ⅰ~Ⅳ级治疗不足的患者比例依次为32.4% (11/34)、53.6%(113/211)、57.6% (178/309)、55.4%(108/195),治疗规范的患者比例依次为23.5% (8/34)、3.8% (8/211)、28.8% (89/309)、33.3% (65/195),治疗过度的患者比例依次为44.1% (15/34)、42.7%(90/211)、13.6% (42/309)、11.3% (22/195);按2013版指南分组:A组93例(12.4%),B组45例(6.0%),C组196例(26.2%),D组415例(55.4%),A~D组治疗不足比例依次为34.4%(32/93)、62.2%(28/45)、67.9% (133/196)、60.7% (252/415),治疗规范比例依次为24.7% (23/93)、4.4% (2/45)、32.1% (63 /196)、39.3%(163/415),治疗过度比例依次为40.9%(38/93)、33.3%(15/45)、0、0.应用两种指南推荐方案对药物治疗情况的判定一致性分析结果显示中等一致性(Kappa=0.534,P<0.001).根据新的指南,143例患者的治疗方案将发生改变,其中,24例(16.8%)需降阶梯治疗,119例(83.2%)需升阶梯治疗.结论 我国慢阻肺门诊患者药物治疗比例较高,但治疗规范比例较低.新的病情评估标准将使更多的患者接受更高级别的药物治疗方案. Objective To survey the present status of medical treatment for Chinese outpatients with chronic obstructive pulmonary disease (COPD) based upon the guidelines for diagnosing and treating COPD (2007 Revised Edition and 2013 Revised Edition) and explore the impact of new guideline on treatment regimens.Methods A retrospective study was conducted at 11 participating hospitals.Stable COPD patients were consecutively recruited from outpatient clinics in China between September 2007 and December 2008 and categorized into the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Ⅰ-Ⅳ classification and A-D groups according to the Chinese guidelines for diagnosing and treating COPD (2007 Revised Edition and 2013 Revised Edition).The authors compared the present status of medical treatment of two guidelines and analyze the impact of new guideline on treatment regimens.Results Among a total of 749 patients,79.2% (593/749) patients received medical treatment.The distribution of classification GOLD Ⅰ-Ⅳ was 34 (4.5%),211 (28.2%),309 (41.3%) and 195 (26.0%).According to the guideline 2007,the patients on medical under-treatment based upon the guidelines in GOLD Ⅰ-Ⅳ classification were 32.4% (11/34),53.6% (113/211),57.6% (178/309) and 55.4% (108/195) ; those on medical treatment:23.5% (8/34),3.8% (8/211),28.8% (89/309) and 33.3% (65/195) ; those on medical over-treatment:44.1% (15/34),42.7% (90/211),13.6% (42/309),11.3% (22/195).The distribution of categories A-D was 93 (12.4%),45 (6.0%),196 (26.2%),and 415 (55.4%).According to guideline 2013,the patients on medical under-treatment were 34.4% (32/93),62.2% (28/45),67.9% (133/196) and 60.7% (252/415) ; those on medical treatment:24.7% (23/93),4.4% (2/45),32.1% (63 /196) and 39.3% (163/415); those on medical over-treatment:40.9% (38/93),33.3 % (15/45),0 and 0.The concordance analysis comparing the judgments of treatment regimens by these two guideline yielded a weighted Kappa coefficient of 0.534 (P <0.001),indicating that there was a moderate degree of judgments between two guidelines.Medical treatment regimens recommended by new guideline was different from old guideline in 143 COPD patients.Among them,24 patients (16.8%) required a step-down therapy while 119 patients (83.2%) a step-up therapy.Conclusions There are more outpatients with COPD on medical treatment,but few of them have received standardized treatment.Compared with the old GOLD classification,more patients are recommended for a step-up therapy by new stratification.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/71070
Appears in Collections:北京大学第三临床医学院_呼吸内科_期刊论文

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作者单位: 1.100191,北京大学第三医院呼吸科
2.中国医科大学附属第一医院呼吸内科
3.北京协和医院呼吸科
4.上海市第一人民医院呼吸科
5.中国石油中心医院呼吸科
6.沈阳军区总医院呼吸内科
7.内蒙古医学院第三附属医院呼吸内科

Recommended Citation:
孙丽娜,陈亚红,常春,等. 新病情评估方法对慢性阻塞性肺疾病稳定期患者药物治疗方案的影响[J]. 中华医学杂志,2015,95(8):570-576.
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