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

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

1.
首都医科大学北京市丰台区方庄社区卫生服务中心，北京 100078
2.
首都医科大学中日友好临床医学院，北京 100069
3.
中日友好医院呼吸中心呼吸与危重症医学科，国家呼吸医学中心，国家呼吸疾病临床医学研究中心，中国医学科学院呼吸病学研究院，世界卫生组织戒烟与呼吸疾病预防合作中心，北京 100029

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
计量
- 文章访问数: 75
- HTML全文浏览量: 19
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- 被引次数: 0
出版历程
- 收稿日期: 2023-03-23
- 网络出版日期: 2024-03-27

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

1.
Fangzhuang Community Health Service Center, Capital Medical University, Beijing 100078, China

摘要

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。
- 慢性阻塞性肺疾病 /
- 6分钟步行试验 /
- DOSE指数 /
- 基层医疗
Abstract: Objective This study aims to explorea method for primary healthcare units to assess exercise endurance impairment in patients with chronic obstructive pulmonary disease (COPD) using the DOSE index as the core indicator. Additionally, the study aims to determine the critical value of this indicator for predicting exercise endurance impairment in patients with COPD. Methods A total of 117 stable COPD patients who were monitored at the China-Japan Friendship Hospital from September 2019 to April 2022 were included in the retrospective analysis. Patients with a six-minute walk distance (6MWD) of less than 350 m were determined to be exercise tolerance. Information on lung function, the modified medical research council (mMRC), smoking status, and acute exacerbations in the previous year was calculate the DOSE index for each patient. Lung function, 6MWD, mMRC scores, and DOSE index were compared between the two groups divided based on 6MWD. The relationship between 6MWD and the DOSE index was investigated using Spearman's correlation analysis; Finally, the effectiveness of the DOSE index in assessing impaired exercise tolerance in COPD patients was analyzed using a receiver operating characteristic (ROC) Curve. Results A total of 117 patients with stable COPD were included in this study. The mean 6MWD was (416.94±117.16) m and the mean DOSE index was 3(1, 5) points. Among the participants, 29 had a 6MWD < 350 m, while 88 had a 6MWD ≥350 m. Significant differences were observed between these two groups in terms of age, FVC%pred, FEV₁%pred, 6MWD, mMRC score, and DOSE index. Notably, there was a strong inverse relationship between the DOSE index and 6MWD (r=-0.456, P < 0.001). Physicians should be particularly vigilant about impaired exercise tolerance in COPD patients. Conclusion The DOSE index, with a predictive threshold of 5 points, exhibits a strong and negative correlation with 6MWD, making it a valuable tool in assessing impaired exercise tolerance among COPD patients. Its simplicity and ease of administration make the DOSE index suitable for implementation in primary healthcare settings.
- Chronic obstructive pulmonary disease /
- 6-minute walk test /
- DOSE index /
- Primary healthcare

HTML全文

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

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表 1 DOSE指数评分规则

Table 1. DOSE index scoring rules

项目	DOSE指数评分(分)
项目	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。

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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值
一般资料[M(P₂₅, P₇₅)]
年龄(岁)	66(61, 71)	64(59, 68)	75(65, 81)	-4.595^a	< 0.001
身高(m)	1.66(1.61, 1.67)	1.66(1.60, 1.67)	1.66(1.63, 1.66)	-0.240^a	0.810
体重(kg)	52.00(52.00, 69.70)	56.00(52.00, 69.40)	52.00(52.00, 70.00)	-0.465^a	0.642
BMI	20.80(18.87, 24.22)	20.20(18.35, 24.01)	20.81(18.87, 24.78)	-0.457^a	0.647
肺功能
FVC%pred(x±s，%)	86.49±22.71	89.06±23.88	78.89±16.98	2.171^b	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)	-2.276^a	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)	-1.706^a	0.088
6MWD(x±s，m)	416.94±117.16	472.51±69.47	254.10±65.58	14.882^b	< 0.001
mMRC评分[M(P₂₅, P₇₅), 分]	2(1, 3)	1(1, 2)	3(2, 3)	-5.141^a	< 0.001
DOSE指数[M(P₂₅, P₇₅), 分]	3(1, 5)	2(1, 4)	5(3, 6)	-3.833^a	< 0.001
注：^a为Z值，^b为t值。FVC%pred为用力肺活量占预计值百分比。

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