慢性阻塞性肺疾病不同表型患者CAT评分与肺功能及预后的相关性分析

摘要 目的：探讨慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）不同表型评估测试问卷（COPD assessment test，CAT）评分与肺功能及预后的关系。方法：收集361例COPD患者临床资料、CAT评分、肺功能检查结果及肺外合并症、肺内并发症等情况，按临床表型分为肺气肿组（n=200）和支气管炎组（n=161），分析肺气肿组200例和支气管炎组161例COPD患者CAT评分与肺功能及预后的关系。结果：肺气肿组CAT评分高于支气管炎组（P<0.05），一秒用力呼气容积（FEV₁）占预计值百分比（FEV₁%）、FEV₁/用力肺活量（FVC）低于支气管炎组（P<0.05），吸气分数（IC/TLC）低于支气管炎组，残总比（RV/TLC）高于支气管炎组（P<0.05）；肺气肿组肺间质性病变、肺动脉高压发生率均高于支气管炎组（P<0.05）；支气管炎、肺气肿组CAT评分均与FEV₁%、FEV₁/FVC、IC/TLC呈负相关（P<0.05），与RV/TLC呈正相关（P<0.05），肺气肿各参数相关度更高（P<0.05）；肺气肿组不同CAT评分患者肺间质性病变、肺动脉高压发生率比较差异有统计学意义（P<0.05），支气管炎组不同CAT评分肺动脉高压发生率比较差异有统计学意义（P<0.05），随CAT评分的升高，肺气肿组肺间质性病变、肺动脉高压发生率上升，支气管炎组肺动脉高压发生率上升。结论： COPD肺气肿表型CAT评分较支气管炎表型高，肺功能降低更明显，呈现肺过度通气，气流受限特点，更易并发肺间质纤维化、肺动脉高压，且与CAT评分变化密切相关。

Correlation between CAT Score and Lung Function and Prognosis of Patients with Different Phenotypes of COPD

ABSTRACT Objective: To investigate the correlation between COPD assessment test (CAT) scores and lung function as well as prognosis of patients of chronic obstructive pulmonary disease (COPD) with different phenotypes. Methods: A total of 361 patients with COPD were involved in this study. Their clinical data, CAT scores, lung function test results, extrapulmonary comorbidities and intrapulmonary complications were collected. Then, these patients were divided into emphysema group (n=200) and the bronchitis group (n=161) according to their clinical phenotype. The correlation was analyzed between CAT scores, lung function, and prognosis in emphysema group and bronchitis group. Results: The CAT score of the emphysema group was higher than that of the bronchitis group (P<0.05). The percentage of forced expiratory volume in one second (FEV₁) of the expected value (FEV₁%) and FEV₁/forced vital capacity (FVC) were lower than those in the bronchitis group (P<0.05). The inspiratory capacity/total lung capacity (IC/TLC) was lower than that of the bronchitis group, and the residual volume/total lung capacity (RV/TLC) was higher than that of the bronchitis group (P<0.05). The incidence rates of pulmonary interstitial disease and pulmonary hypertension in the emphysema group were higher than those in the bronchitis group (P<0.05). The CAT scores of both groups were negatively correlated with FEV₁%, FEV₁/FVC and IC/TLC (P<0.05), and positively correlated with RV/TLC (P<0.05). The correlation of emphysema parameters was higher (P<0.05). There were statistically significant differences in the incidence rates of pulmonary interstitial disease and pulmonary hypertension between patients with different CAT scores in emphysema group(P<0.05). There was a statistically significant difference in the incidence of pulmonary hypertension between patients with different CAT scores in the bronchitis group(P<0.05). As the CAT score increased, the incidence rates of pulmonary interstitial disease and pulmonary hypertension in the emphysema group increased, and the incidence rate of pulmonary hypertension in the bronchitis group increased. Conclusion: The CAT score of patients with emphysema phenotype of COPD is higher than those with bronchitis phenotype. Besides, lung function decline is more obvious in the former group, showing characteristics of pulmonary hyperventilation and restricted airflow. The former are more likely to have pulmonary fibrosis and pulmonary arterial hypertension, which is closely related to changes in CAT scores.