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DOSE指数对社区稳定期慢性阻塞性肺疾病患者运动耐力受损的评估价值

杨露露 时明慧 何佳泽 曲木诗玮 杨汀

杨露露, 时明慧, 何佳泽, 曲木诗玮, 杨汀. DOSE指数对社区稳定期慢性阻塞性肺疾病患者运动耐力受损的评估价值[J]. 中华全科医学, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382
引用本文: 杨露露, 时明慧, 何佳泽, 曲木诗玮, 杨汀. DOSE指数对社区稳定期慢性阻塞性肺疾病患者运动耐力受损的评估价值[J]. 中华全科医学, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382
YANG Lulu, SHI Minghui, HE Jiaze, QUMU Shiwei, YANG Ting. Study on the value of the DOSE index in assessing impaired exercise tolerance in community patients with stable chronic obstructive pulmonary disease[J]. Chinese Journal of General Practice, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382
Citation: YANG Lulu, SHI Minghui, HE Jiaze, QUMU Shiwei, YANG Ting. Study on the value of the DOSE index in assessing impaired exercise tolerance in community patients with stable chronic obstructive pulmonary disease[J]. Chinese Journal of General Practice, 2024, 22(2): 273-276. doi: 10.16766/j.cnki.issn.1674-4152.003382

DOSE指数对社区稳定期慢性阻塞性肺疾病患者运动耐力受损的评估价值

doi: 10.16766/j.cnki.issn.1674-4152.003382
基金项目: 

国家自然科学基金青年科学基金项目 82200051

中国医学科学院医学与健康科技创新工程项目 2021-I2M-1-049

详细信息
    通讯作者:

    杨汀,E-mail: zryyyangting@163.com

  • 中图分类号: R563

Study on the value of the DOSE index in assessing impaired exercise tolerance in community patients with stable chronic obstructive pulmonary disease

  • 摘要:   目的  以DOSE指数为核心指标,探究一种适合基层医疗单位用于简易评估慢性阻塞性肺疾病(简称慢阻肺)患者运动耐力受损的方法。并确定该指标对于预测慢阻肺患者运动耐力受损的价值及其临界值。  方法  本研究为回顾性研究,纳入中日友好医院2019年9月—2022年4月进行随访的117名稳定期慢阻肺患者,所有患者均进行6分钟步行试验(6MWT),以6分钟步行距离(6MWD) < 350 m认为运动耐力受损。同时收集所有患者的肺功能、改良英国医学研究学会呼吸困难指数(mMRC)、吸烟情况和过去1年急性加重情况并计算DOSE指数。根据6MWD进行分组,比较2组间肺功能、6MWD、mMRC评分和DOSE指数的差异。利用Spearman相关性分析探究6MWD与DOSE指数间的关系;通过ROC分析DOSE指数评估慢阻肺患者存在运动耐力受损的价值。  结果  117例稳定期慢阻肺患者6MWD为(416.94±117.16)m,DOSE指数为3(1, 5)分。其中6MWD < 350 m者29例,6MWD≥350 m者88例,2组患者年龄、FVC%pred、FEV1%pred、6MWD、mMRC评分、DOSE指数比较差异均有统计学意义(P<0.05)。6MWD与DOSE指数呈负相关关系(r=-0.456,P < 0.001)。DOSE指数为5分时对应的约登指数最大,是其评估慢阻肺患者运动耐力受损的Cut-off值。  结论  DOSE指数可作为评估慢阻肺患者是否存在运动耐力受损的重要补充,其预测临界阈值为5分。由于DOSE指数简便易行,适合推广到基层医疗机构。

     

  • 图  1  DOSE指数预测6MWD < 350 m的ROC曲线

    Figure  1.  ROC curve of DOSE index predicting 6MWD < 350 m

    表  1  DOSE指数评分规则

    Table  1.   DOSE index scoring rules

    项目 DOSE指数评分(分)
    0 1 2 3
    mMRC评分(D) 0~1 2 3 4
    FEV1%pred(O) >50 30~50 < 30
    当前吸烟状态(S) 吸烟 不吸烟
    1年内急性加重次数(E) 0~1 2~3 >3
    注:FEV1%pred为第1秒用力呼气量占预计值百分比。
    下载: 导出CSV

    表  2  不同组别的慢阻肺患者人群特征比较

    Table  2.   Comparison of population characteristics of COPD patients in different groups

    项目 总体(n=117) 6MWD≥350 m(n=88) 6MWD < 350 m(n=29) 统计量 P
    一般资料[M(P25, P75)]
      年龄(岁) 66(61, 71) 64(59, 68) 75(65, 81) -4.595a < 0.001
      身高(m) 1.66(1.61, 1.67) 1.66(1.60, 1.67) 1.66(1.63, 1.66) -0.240a 0.810
      体重(kg) 52.00(52.00, 69.70) 56.00(52.00, 69.40) 52.00(52.00, 70.00) -0.465a 0.642
      BMI 20.80(18.87, 24.22) 20.20(18.35, 24.01) 20.81(18.87, 24.78) -0.457a 0.647
    肺功能
      FVC%pred(x±s,%) 86.49±22.71 89.06±23.88 78.89±16.98 2.171b 0.037
      FEV1%pred[M(P25, P75), %] 52.00(34.20, 72.20) 52.3(38.20, 72.90) 37.94(28.30, 66.30) -2.276a 0.023
      FEV1/FVC[M(P25, P75), %] 44.35(35.26, 57.31) 44.94(37.12, 58.99) 40.27(28.99, 55.51) -1.706a 0.088
      6MWD(x±s,m) 416.94±117.16 472.51±69.47 254.10±65.58 14.882b < 0.001
      mMRC评分[M(P25, P75), 分] 2(1, 3) 1(1, 2) 3(2, 3) -5.141a < 0.001
      DOSE指数[M(P25, P75), 分] 3(1, 5) 2(1, 4) 5(3, 6) -3.833a < 0.001
    注:aZ值,bt值。FVC%pred为用力肺活量占预计值百分比。
    下载: 导出CSV
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  • 收稿日期:  2023-03-23
  • 网络出版日期:  2024-03-27

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