GOLD 2011 disease severity classification in COPDGene: a prospective cohort study.
GOLD 2011 disease severity classification in COPDGene: a prospective cohort study.
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DOI：
10.1016/s2213-2600(12)70044-9
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发表时间：
2013-03
影响因子：
76.2
通讯作者：
Make, Barry J.
中科院分区：
文献类型：
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作者：
Han, MeiLan K.;Muellerova, Hana;Curran-Everett, Douglas;Dransfield, Mark T.;Washko, George R.;Regan, Elizabeth A.;Bowler, Russell P.;Beaty, Terri H.;Hokanson, John E.;Lynch, David A.;Jones, Paul W.;Anzueto, Antonio;Martinez, Fernando J.;Crapo, James D.;Silverman, Edwin K.;Make, Barry J.
2011年全球慢性阻塞性肺病诊断、管理和预防战略（GOLD）共识报告使用症状、加重史和FEV1%来定义四个类别：A，低症状/低风险；B，高症状/低风险；C，低症状/高风险；D，高症状/高风险，其中风险指病情恶化、住院和死亡。我们的目的是确定(1)症状工具对类别成员的影响和(2)按类别划分的预期恶化风险。对来自COPDGene的4,484名COPD患者进行了分析。所有受试者吸烟史≥10包年，FEV1/FVC< 0.7。使用改良的医学研究委员会呼吸困难评分（mMRC）（0-1对≥2）和圣乔治呼吸调查问卷（SGRQ）（≥25对<25，代替COPD评估测试≥10对<10）以及预测FEV1%（≥50对<50）来定义类别。使用mMRC和SGRQ的分类分配相似但不完全相同。使用mMRC，分类分配为34% A， 21% B， 8% C和38% D， SGRQ为29% A， 25% B， 5% C和41% D （kappa= 0.77）。加重率（加重次数/人年）的显著异质性在D组尤为明显，这取决于决定分类分配的危险因素(肺功能（0.89）、既往加重史（1.34）或两者兼有（1.86），p< 0.001。GOLD分类强调在评估COPD严重程度时症状和恶化风险的重要性。症状测量的选择影响类别分配。低症状和高风险加重（C类）的受试者相对数量较少。最高风险D类受试者的加重率差异取决于风险是基于肺功能、加重史还是两者兼而有之。
The 2011 Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) consensus report uses symptoms, exacerbation history and FEV1% to define four categories: A, low symptoms/low risk; B, high symptoms/low risk; C, low symptoms/high risk; and D, high symptoms/high risk where risk refers to exacerbations, hospitalization and death. Our objective was to determine (1) the influence of symptom instrument on category membership and (2) prospective exacerbation risk by category. 4,484 COPD subjects from COPDGene were analyzed. All subjects had smoking history ≥ 10 pack-years and FEV1/FVC<0·7. Categories were defined using the modified Medical Research Council Dyspnea [mMRC] (0–1 versus ≥ 2) and the Saint George’s Respiratory Questionnaire [SGRQ] (≥25 versus <25 as a surrogate for the COPD Assessment Test ≥ 10 versus <10) in addition to COPD exacerbations in the prior year (<2 versus ≥ 2), and FEV1% predicted (≥50 versus <50). Category assignment using mMRC versus SGRQ were similar but not identical. Using the mMRC, category assignments were 34% A, 21% B, 8% C and 38% D and for SGRQ were 29% A, 25% B, 5% C and 41% D (kappa=0·77). Significant heterogeneity in exacerbation rates (exacerbations/person-year) were seen particularly within the D group, depending on the risk factor that determined category assignment (lung function (0·89), prior exacerbation history (1·34) or both (1·86), p<0·001. The GOLD classification emphasizes the importance of symptoms and exacerbation risk in assessing COPD severity. The choice of symptom measure influences category assignment. The relative number of subjects with low symptoms and high risk for exacerbations (category C) is low. Differences in exacerbation rates for subjects in the highest risk category D were seen depending on whether risk was based on lung function, exacerbation history or both.