Prediction of the Clinical Course of Chronic Obstructive Pulmonary Disease, Using the New GOLD Classification A Study of the General Population
Prediction of the Clinical Course of Chronic Obstructive Pulmonary Disease, Using the New GOLD Classification A Study of the General Population
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DOI：
10.1164/rccm.201207-1299oc
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发表时间：
2012-11-15
影响因子：
24.7
通讯作者：
Nordestgaard, Borge Gronne
中科院分区：
文献类型：
--
作者：
Lange, Peter;Marott, Jacob Louis;Nordestgaard, Borge Gronne
理由：新的阻塞性肺病全球倡议 (GOLD) 根据症状、肺功能水平和恶化史将慢性阻塞性肺病 (COPD) 分为 A、B、C 和 D 类。目标：调查该分层预测 COPD 临床病程的能力。方法：在哥本哈根地区进行了两项类似的人群研究，包括 6,628 名 COPD 患者。测量和主要结果：平均对患者进行 4.3 年的监测，了解 COPD 恶化、入院情况和死亡率。观察第一年期间出现 COPD 恶化的个体百分比，A 组为 2.2%，B 组为 5.8%，C 组为 25.1%，D 组为 28.6%。A 组一年和 3 年死亡率分别为 0.6% 和 3.8%，B 组为 3.0% 和 10.6%，C 组为 0.7% 和 8.2%， D 组为 3.4%，D 组为 20.1%。B 组和 D 组的呼吸困难程度高于 A 组和 C 组，其心血管疾病和癌症死亡率是 A 组和 C 组的 5 至 8 倍。结论：新的分层通过识别有病情加重风险的个体表现良好。令人惊讶的是，尽管 FEV1 水平较高，但以呼吸困难更严重为特征的 B 亚组的生存率明显低于 C 组。该亚组值得特别关注，因为预后不良可能是由心血管疾病或癌症引起的，需要额外的评估和治疗。
Rationale: The new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations.Objectives: To investigate the abilities of this stratification to predict the clinical course of COPD.Methods: Two similar population studies were performed in an area of Copenhagen including 6,628 individuals with COPD.Measurements and Main Results: The patients were monitored for an average period of 4.3 years regarding COPD exacerbations, hospital admissions, and mortality. The percentages of individuals experiencing a COPD exacerbation during the first year of observation were 2.2% in group A, 5.8% in group B, 25.1% in group C, and 28.6% in group D. One- and 3-year mortality rates were 0.6 and 3.8%, respectively, in group A, 3.0 and 10.6% in group B, 0.7 and 8.2% in group C, and 3.4 and 20.1% in group D. Groups B and D, characterized by a higher degree of dyspnea than groups A and C, had five to eight times higher mortality from cardiovascular disease and cancer than did groups A and C.Conclusions: The new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, had significantly poorer survival than group C, in spite of a higher FEV1 level. This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.