健康干预对上海市浦东新区社区轻中度慢性阻塞性肺疾病患者运动能力的影响

常睿; 吴抗; 邱华; 肖甜; 阮晓楠; 王娜; 付朝伟

doi:10.16462/j.cnki.zhjbkz.2021.11.013

健康干预对上海市浦东新区社区轻中度慢性阻塞性肺疾病患者运动能力的影响

doi: 10.16462/j.cnki.zhjbkz.2021.11.013

常睿¹,
吴抗²,
邱华²,
肖甜¹,
阮晓楠²,
王娜¹,
付朝伟^1, ,

1.
200032 上海，复旦大学公共卫生学院流行病学教研室，公共卫生安全教育部重点实验室，国家卫生健康委员会卫生技术评估重点实验室
2.
200136 上海，上海浦东新区疾病预防控制中心，复旦大学浦东预防医学研究院

基金项目:

国家重点研发计划 2018YFC1313600

上海市卫生和计划生育委员会基金 201540415

详细信息

通讯作者:
付朝伟，E-mail: fcw@fudan.edu.cn

中图分类号: R181.2+4
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出版历程
- 收稿日期: 2020-09-08
- 修回日期: 2020-12-11
- 网络出版日期: 2021-12-04
- 刊出日期: 2021-11-10

Effect of health intervention on exercise capacity of patients with mild to moderate chronic obstructive pulmonary disease in Pudong New Area, Shanghai

1.
Department of Epidemiology, School of Public Health, Fudan University, Key Laboratory of Public Health and Safety Education Ministry, Key Laboratory of Health Technology Assessment of National Health Commission, Shanghai 200032, China
2.
Shanghai Pudong New Area Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai 200136 China

Funds:

National Key R & D Program of China 2018YFC1313600

Shanghai Health and Family Planning Commission Fund 201540415

More Information

Corresponding author: FU Chao-wei, E-mail: fcw@fudan.edu.cn

摘要

摘要: 目的评价健康干预对上海市浦东新区社区轻中度慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者运动能力的影响。方法从上海市浦东新区所有社区中随机整群抽样抽取10个社区并分为干预组和对照组，将所有在册轻中度COPD患者作为调查对象，进行面对面的问卷调查收集基本资料。6个月内针对干预组进行多次健康干预活动，并在干预前后利用六分钟步行试验(six-minute walk test, 6MWT)和Borg主观体力感等级量表评分评价COPD患者的运动能力。使用秩和检验与双重差分(difference in difference, DID)分析模型比较健康干预前后干预组与对照组步行距离和各项评分差值的差异。结果调整相关协变量后男性组、女性组、整体人群步行距离的前后差异均无统计学意义(均有P>0.05)；干预组呼吸困难评分差值、疲劳评分差值均大于对照组且差异均有统计学意义(Z₁=-4.636, P₁ < 0.001; Z₂=-4.912, P₂ < 0.001)；调整相关协变量后男性呼吸困难评分、疲劳评分和女性疲劳评分的前后差异均为负(均有P < 0.05)。结论健康干预措施缓解了轻中度COPD患者呼吸困难和疲劳状况，提高了上海市浦东新区社区轻中度COPD患者运动能力。
- 慢性阻塞性肺疾病 /
- 健康干预 /
- 运动能力 /
- 六分钟步行试验 /
- Borg主观体力感等级量表
Abstract: Objective To evaluate the effect of health intervention on the exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in the community of Pudong New Area, Shanghai. Methods A random cluster sampling was used to select 10 communities from all communities in Pudong New Area, Shanghai, and divided them into the intervention group and the control group. All registered patients with mild to moderate COPD were taken as survey subjects, and a face-to-face questionnaire survey was conducted to collect basic data. Conduct multiple health intervention activities for the intervention group within 6 months, and the six-minute walk test (6MWT) and Borg subjective physical strength rating scale were used to evaluate the exercise ability of COPD patients before and after the intervention. The rank sum test and the difference in difference (DID) analysis model were used to compare the differences in walking distance and various score differences between the intervention group and the control group before and after the health intervention. Results After adjusting the relevant covariates, there was no significant difference in walking distance between the male group, female group, and the overall population (all P>0.05); The difference in dyspnea scores and fatigue scores in the intervention group were greater than those in the control group, and the differences were statistically significant (Z₁=-4.636, P₁ < 0.001; Z₂=-4.912, P₂ < 0.001). After adjusting the relevant covariates, the differences in male dyspnea score, fatigue score, and female fatigue score were all negative and all P < 0.05. Conclusion Health intervention measures relieved dyspnea and fatigue in patients with mild to moderate COPD, and improved the exercise capacity of patients with mild to moderate COPD in the Pudong New Area, Shanghai.
- Chronic obstructive pulmonary disease /
- Health intervention /
- Exercise capacity /
- Six-minute walk test /
- Borg subjective physical strength rating scale

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表 1 2016年上海市浦东新区社区轻中度COPD患者的一般情况[n(%)]

Table 1. The general situation of patients with mild to moderate COPD in Pudong New Area, Shanghai in 2016 [n(%)]

变量	干预组 (n=155)	对照组 (n=127)	χ²/t/Z值	P值
性别			13.267	< 0.001
男	59(38.06)	76(59.84)
女	96(61.94)	51(40.16)
年龄(x±s, 岁)	64.32±5.71	64.11±5.59	0.305	0.760
病程[M(P₂₅, P₇₅), 年]	8.0(5.0, 15.0)	5.0(4.0, 10.0)	-3.044	0.002
BMI(x±s, kg/m²)	24.95±3.92	24.17±3.24	1.828	0.069
婚姻状况			0.045	0.832
有配偶	145(93.55)	118(92.91)
无配偶	10(6.45)	9(7.09)
是否完成义务教育			11.605	< 0.001
是	68(43.87)	31(24.41)
否	87(56.13)	96(75.59)
家庭人均月收入(元)
< 3 000	89(57.42)	54(42.52)	6.200	0.013
≥3 000	66(42.58)	73(57.48)
吸烟状况			8.082	0.018
不吸烟	105(67.74)	65(51.18)
吸烟	22(14.19)	29(22.83)
已戒烟	28(18.06)	33(25.98)
饮酒状况			4.887	0.087
饮酒	21(13.55)	30(23.62)
不饮酒	132(85.16)	95(74.80)
已戒酒	2(1.29)	2(1.57)
体育锻炼频率(次/周)			1.873	0.392
< 1	80(51.61)	56(44.10)
1~ < 3	13(8.39)	10(7.87)
≥3	62(40.00)	61(48.03)
是否高血压			1.071	0.301
是	73(47.10)	52(40.94)
否	82(52.90)	75(59.06)
是否糖尿病			2.989	0.084
是	24(15.48)	11(8.66)
否	131(84.52)	116(91.34)
近1年是否规律用药			4.578	0.101
未服药	93(60.00)	63(49.61)
是	46(29.68)	41(32.28)
否	16(10.32)	23(18.11)

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表 2 轻中度COPD患者接受健康干预前后步行距离差值和Borg评分差值

Table 2. Differences in walking distance and Borg score before and after health interventions in patients with mild to moderate COPD

变量	干预组	对照组	Z值	P值
步行距离差值(m)
男性	4.0(-41.0, 74.0)	33.0(-28.0, 110.0)	-1.366	0.172
女性	-11.5(-54.0, 30.0)	53.0(4.0, 121.0)	-4.022	< 0.001
合计	-8.0(-52.0, 42.0)	34.0(-14.0, 113.0)	-4.067	< 0.001
呼吸困难评分差值(分)
男性	0.0(-0.5, 0.0)	0.0(0.0, 0.5)	-3.338	0.002
女性	0.0(-1.0, 0.0)	0.0(0.0, 0.0)	-2.855	0.002
合计	0.0(-0.5, 0.0)	0.0(0.0, 0.0)	-4.636	< 0.001
疲劳评分差值(分)
男性	0.0(-0.5, 0.0)	0.0(0.0, 0.5)	-3.473	< 0.001
女性	0.0(-0.5, 0.0)	0.0(0.0, 1.0)	-3.049	< 0.001
合计	0.0(-0.5, 0.0)	0.0(0.0, 0.5)	-4.912	< 0.001

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表 3 轻中度COPD患者接受健康干预前后步行距离和Borg评分双重差分分析结果

Table 3. Results of difference in difference analysis of walking distance and Borg score before and after health intervention in patients with mild to moderate COPD

变量	男性		女性		合计
变量	前后差异	P值	前后差异	P值	前后差异	P值
步行距离(m)	-28.63	0.249	-83.31	< 0.001	-57.06	0.001
调整后步行距离^a(m)	1.46	0.939	14.95	0.420	6.13	0.636
呼吸困难评分(分)	-0.27	0.109	0.01	0.958	-0.65	< 0.001
调整后呼吸困难评分^a(分)	-0.52	0.006	-0.28	0.087	-0.35	0.003
疲劳评分(分)	-0.42	0.001	-0.40	0.001	-0.66	< 0.001
调整后疲劳评分^a(分)	-0.53	< 0.001	-0.52	< 0.001	-0.55	< 0.001
注：^a模型校正了性别、年龄、婚姻状况、是否完成义务教育、家庭人均月收入、BMI、是否患有高血压、是否患有糖尿病、是否患有其他肺部疾病、是否规律用药、是否了解肺功能、吸烟状况。

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