安徽省居民慢性阻塞性肺疾病诊断和防控状况分析

查震球; 何玉琢; 徐伟; 樊静; 刘志荣; 方利文

doi:10.11847/zgggws1128159

安徽省居民慢性阻塞性肺疾病诊断和防控状况分析

Diagnosis, control and prevention of chronic obstructive pulmonary disease among middle-aged and elderly residents in Anhui province

摘要

摘要:
目的了解安徽省居民慢性阻塞性肺疾病（COPD）诊断和防控状况，为COPD的防治提供参考依据。
方法于2015年1 — 6月采用多阶段分层整群随机抽样方法在安徽省5个COPD监测点抽取2996名 ≥ 40岁常住居民进行问卷调查，并对其中2815名无肺功能检查禁忌症者进行舒张实验前后肺功能检查。
结果安徽省5个COPD监测点2815名无肺功能检查禁忌症者经肺功能检查共诊断出COPD患者272例，COPD患者中既往慢性支气管炎、肺气肿、哮喘、COPD和慢性呼吸系统疾病患病率分别为15.5 %、4.1 %、6.3 %、0.4 %和18.2 %。有33.1 %的慢性支气管炎患者、55.0 %的肺气肿患者、33.3 %的哮喘患者和31.8 %的慢性呼吸系统疾病患者在本次肺功能检查中被诊断为COPD患者，既往慢性支气管炎、肺气肿、哮喘和慢性呼吸系统疾病与本次肺功能诊断COPD均呈正相关性（r = 0.17、0.13、0.11和0.18，均P < 0.001），Kappa值分别为0.16、0.06、0.08和0.17。安徽省2996名 ≥ 40岁常住居民中，曾做过肺功能检查者51人，肺功能检查率为2.0 %；现在吸烟者843人，现在吸烟率为28.3 %；现在每日吸烟者758人，现在每日吸烟率为25.2 %。不同特征居民比较，有慢性呼吸系统疾病者、有呼吸道症状者、肺功能检查诊断COPD患者的现在吸烟率和每日吸烟率分别为42.0 %和39.2 %、34.9 %和33.2 %、53.6 %和48.4 %，均高于无慢性呼吸系统疾病者、无呼吸道症状者、肺功能检查诊断非COPD患者的27.3 %和24.2 %、27.5 %和24.2 %、25.4 %和22.6 %，差异均有统计学意义（均P < 0.001）。
结论安徽省COPD诊断不足，漏诊情况较严重，COPD患者未得到及时诊断；居民肺功能检查率较低，有慢性呼吸系统疾病和症状者现在吸烟情况较为严重。

Abstract:
Objective To investigate current situation of diagnosis, control and prevention of chronic obstructive pulmonary disease (COPD) among middle-aged and elderly residents in Anhui province for providing evidences to COPD prevention and control.
Methods Using stratified multistage cluster random sampling, we recruited 2 996 residents aged ≥ 40 years at 5 COPD surveillance sites across Anhui province and conducted a questionnaire survey and physical examination among the participants during January – June, 2015. For the diagnosis of COPD, lung function measurement before and after bronchial dilation test were performed among 2 815 participants without relevant contraindications.
Results Totally 272 COPD patients were diagnosed among all participants undergoing lung function testing. Among the COPD patients diagnosed, the prevalence rates of previously diagnosed diseases were 15.5% for chronic bronchitis, 4.1% for emphysema, 6.3% for asthma, 0.4% for previously diagnosed COPD, and 18.2% for other chronic respiratory diseases; among the patients with previously diagnosed chronic bronchitis, emphysema, asthma, and chronic respiratory diseases, the detection rate of COPD were 33.1%, 55.0%, 33.3%, and 31.8%; the COPD detection rate was positively correlated with previous history of chronic bronchitis, emphysema, asthma, and chronic respiratory diseases, with the correlation coefficients of 0.17, 0.13, 0.11, and 0.18 (all P < 0.001) and the Kappa values of 0.16, 0.06, 0.08, and 0.17, respectively. Of all the participants, only 2.0% (51) reported previous lung function testing; 28.3% (843) and 25.2% (758) were current and daily smokers and the prevalence rate of current and daily smoking were significantly higher among the participants with chronic respiratory diseases (42.0% vs. 27.3% and 39.2% vs. 24.2%), respiratory disease symptoms (34.2% vs. 27.5% and 33.2% vs. 24.2%), and COPD detected in lung function testing (53.6% vs. 25.4% and 48.4% vs. 22.6%) compared with the participants without those diseases or symptoms (all P < 0.001).
Conclusion Among middle-aged and elderly residents in Anhui province, the missed diagnosis of COPD is prevalent; the rate of having lung function testing is low; and the smoking rate is high among the residents with chronic respiratory diseases and symptoms.

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