国际权威的医学学术期刊American Journal of Respiratory and Critical Care Medicine近日刊登了一篇关于罗马提案：慢性阻塞性肺疾病加重的最新定义和严重程度分类《An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal》。

        文章概要如下

        200多年前，发表了第一篇关于肺气肿的文章，肺气肿是今天所谓的慢性阻塞性肺病(copd)的一个重要病理生物学因素。

        目前关于ECOPD的定义有几个不足，这些缺点对临床和卫生保健决策产生了影响：

        01

        首先，它依赖于病人对增加的呼吸道症状的主观感受，这种感知因病人而异，并且可以被其他情况(如肺炎、心脏事件或肺栓塞)影响。

        02

        其次，它没有将症状与可衡量的病理生理变量联系起来，而这些病理生理变量可以受事件本身影响。

        03

        最后，他缺少关于触发事件发展的框架，一个可以帮助区分将ECOPDS从其他具有类似症状进展区分开来。

        为了解决限制，该提案主张将疾病按严重程度分类，分为轻度、中度、重度。主要是根据呼吸困难、上静脉血氧饱和度、呼吸率、心率、血清 c 反应蛋白(C反应蛋白) ，动脉血气来评估。

        在罗马提案中，关于慢性阻塞性肺疾病急性加重的定义为，COPD的患者，在14天内，具备呼吸困难加重、咳嗽/咳痰性状的改变，可以伴有呼吸困难或心动过速，统筹与气道感染、空气污染或其他对呼吸道损害有关。

        以下为评分具体情况：

        (其中HR为心率，RR为呼吸频率，CAS为可视化模拟刻度)

        结论：这个经过修订的定义可以解决当前定义的许多缺点，应该更好地为临床护理、研究提供信息，但仍需要更多研究中进行前瞻性验证。

        ▶参考文献：

        【1】Laennec RTH; Forbes J, editor. A treatise on the diseases of the chest. London, UK: T & G Underwood; 1821.

        【2】Wedzicha JA, Donaldson GC. Exacerbations of chronic obstructive pulmonary disease. Respir Care 2003;48:1204–1213, discussion 1213–1215.

        【3】Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007;29:1224–1238.

        【4】Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196–204.

        【5】Wedzicha JA, Calverley PMA, Albert RK, Anzueto A, Criner GJ, Hurst JR, et al. Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017;50:1600791.

        【6】Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest 2000;117:398S–401S.

        【7】Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Fontana, WI: Global Initiative for Chronic Obstructive Lung Disease; 2021; [accessed 2021 May 24]. Available from: https://goldcopd.org/2021-gold-reports/.

        【8】Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med 2019;381:1257–1266.

        【9】Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ, Light RW, et al.; Department of Veterans Affairs Cooperative Study Group. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1999;340:1941–1947.

        【10】Scioscia G, Blanco I, Arismendi E, Burgos F, Gistau C, Foschino Barbaro MP, et al. Different dyspnoea perception in COPD patients with frequent and infrequent exacerbations. Thorax 2017;72:117–121.

        【11】Donaldson GC, Hurst JR, Smith CJ, Hubbard RB, Wedzicha JA. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010;137:1091–1097.

        【12】Kunisaki KM, Dransfield MT, Anderson JA, Brook RD, Calverley PMA, Celli BR, et al.; SUMMIT Investigators. Exacerbations of chronic obstructive pulmonary disease and cardiac events: a post hoc cohort analysis from the SUMMIT randomized clinical trial. Am J Respir Crit Care Med 2018;198:51–57.

        【13】Calverley PMA. Minimal clinically important difference: exacerbations of COPD. COPD 2005;2:143–148.

        【14】Effing TW, Kerstjens HAM, Monninkhof EM, van der Valk PDLPM, Wouters EFM, Postma DS, et al. Definitions of exacerbations: does it really matter in clinical trials on COPD? Chest 2009;136:918–923.

        【15】Botsis T, Ball R. Automating case definitions using literature-based reasoning. Appl Clin Inform 2013;4:515–527.