The Application Of GOLD Comprehensive Assessment Index In Patients With Chronic Obstructive Pulmonary Disease At High Altitude

Objective:To evaluate the value of comprehensive evaluation index of the Global Initiative for Chronic Obstructive Lung Disease?GOLD?in patients at high altitude.Methods:175 patients with COPD who were admitted in the respiratory department of Qinghai University University Affiliated Hospital from March 2016 to November2017.The general information,the GOLD comprehensive evaluation index?FEV1%pred,annual exacerbation frequency,CAT scores,mMRC classification?and PaO_2,PaCO₂ PASP,6MWD,hemoglobin,the complications were collected.The relationship of the GOLD comprehensive evaluation index and the difference of two evaluation methods?the GOLD2016 and the GOLD2017?in dividing group type were studied.Results:1.The annual exacerbation frequency of GOLD 3 was significantly higher than GOLD 2?P<0.05?;the mMRC classification of grade 4 was significantly higher than that of GOLD 1,2 and 3?all P<0.05?;the CAT scores of GOLD 3 and 4 were significantly higher than those of GOLD 1 and 2?all P<0.05?;the PaCO₂ of GOLD 4was significantly higher than that of GOLD 1,2 and 3?all P<0.05?;the hemoglobin of GOLD 4 was significantly higher than that of GOLD 1?P<0.05?;the PaO_2,6MWD of GOLD 4 was significantly lower than those of GOLD 1 and 2,GOLD 3was significantly lower than those of GOLD 1?all P<0.05?.There were 14?45.2%?and 47?63.5%?patients with respiratory failure in GOLD 1 and 2,3?9.7%?and4?5.4%?patients with pulmonary hypertension,15?48.4%?and 49?66.2%?patients with activity tolerance decreased,and 7?22.6%?and 32?43.2%?with hemoglobin increased in GOLD 1 and 2.There was a progressive increase in the percentage of cases with respiratory failure,pulmonary hypertension,exercise tolerance decreased and hemoglobin increased in GOLD 3 and 4.2.There were moderate correlation between CAT scores and FEV1%pred,mMRC?r=-0.414,r=0.441,respectively,all P<0.01?;But there were no significant correlation between CAT scores and FEV1%pred in GOLD 1 to 3?all P>0.05?;There were no significant difference of CAT scores in mMRC classification 0 to 4,1 and 2,3 and 4?all P>0.05?.3.There were significant differences of the patients in four groups between GOLD2016 and GOLD2017 methods?all P<0.05?;1 patient was assigned in group C with GOLD2016 but in group A with GOLD2017 methods and 39 patients were assigned in group D with GOLD2016 but in group B with GOLD2017 methods.There were no significant difference of PaO₂,PaCO₂,PASP,6MWD,hemoglobin and the complications between 39 variant patients and group D patients assessed by two methods?all P>0.05?.The PaO₂ and 6MWD in 39 variant patients were significantly lower than group B patients assessed by two methods?P<0.05?.Conclusions:1.The patients with COPD at high altitude are more likely appear respiratory failure,pulmonary hypertension,increased hemoglobin and reduced activity endurance early and heavy;2.The correlation among GOLD comprehensive evaluation index are less relevant and exist Controversial in patients with COPD;at high altitude;3.The comprehensive assessment in GOLD2017 may underestimate the condition of patients with COPD at high altitude and degrade the treatment.