COPD全球创意(GOLD)在我国应用的可行性探讨

目的:了解COPD全球创意(GOLD)诊断分级标准和我国现行的COPD诊断分级标准两者之间的差异,探讨GOLD诊断分级标准在我国应用的可行性。方法:回顾性调查235例曾经疑诊或确诊为COPD患者的病史、吸烟史、临床诊断和肺通气功能,比较国内现行诊断分级标准和GOLD诊断分级标准两者在诊断效能、对患者覆盖范围及肺功能指标FEV_1％Pre和FEV_1/FVC界值合理性的差别。结果:两种诊断分级标准的诊断效能表面上很接近,而实际上有显著的差别(X~2=131.546,P<0.001);原因在于两者肺功能指标的界值不同,GOLD诊断标准早期发现15例COPDⅠ期患者为国内现行标准所不能覆盖,而国内现行标准中也有12例COPD患者实为限制性通气障碍(其中2例合并有阻塞性通气障碍)。FEV_1％Pre和FEV_1/FVC的界值在国内现行标准中表现为相互矛盾,而GOLD标准比国内现行标准显得更为合理。结论:(1)GOLD诊断分级标准和我国现行的诊断标准有明显的不同;(2)GOLD诊断分级标准比我国现行的诊断标准更适合我国的COPD诊断分级;(3)GOLD诊断分级标准比我国现行的诊断标准具有更好的客观性、早期性和合理性。

The Feasibility to Apply Global Initiative for Chronic Obstructive Lung Disease (GOLD) in China

To understand the difference between the criterion of Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the criterion of national existent for COPD. To discuss the feasibility about using GOLD in China. Methods: The medical and smoke histroy, clinic diagnoses and pulmonary function of 235 patients with doubtful diagnoses or final diagnoses of COPD were retrospectively investigated. The difference about the diagnosis efficacy, the cases involved and the rationality for cutoff point of FEV1 %Pre and FEV1/FVC were compared within both the GOLD criterion and the national existent criterion. Results: The diagnosis efficacy of two methods are apparently similar but actually different obviously (x2 = 131.546, P < 0.001). The reason of the difference is the different cutoff points of pulmonary function in two criterions. There are 15 cases of GOLD I phase with COPD who can not be covered by national existent criterion at all and there are 12 cases with restrictive ventilation disorder ( 2 cases with comorbidited obstructive ventilation disorder) who are misdiagnosed for COPD. The cutoff points of GOLD are more rational than that of national existent criterion in which the the cutoff points of FEV1 %Pre and FEV1/FVC are self-contradictory. Conclusions: 1. GOLD criterion is obviously different from national existent criterion; 2. GOLD criterion is more suitable for the diagnoses and classification of COPD than that of national existent criterion; 3. GOLD criterion is more objective, more earlier and more rational than national existent criterion.