县域住院患者慢性阻塞性肺疾病主动筛查风险分层及优先级方案构建研究
Development of a Risk Stratification and Priority Scheme for Active Chronic Obstructive Pulmonary Disease Screening among Inpatients in County-level Hospitals
萧鲲 1梁振宇 2梁匡迪 3李美怡 4梁兰芳 4许浦生5
作者信息
- 1. 510450 广东省广州市，广州市第一人民医院白云医院（广州市白云区第二人民医院）呼吸与危重症医学科;510080 广东省广州市，广东省健康管理学会基层医疗及健康教育专业委员会
- 2. 510120 广东省广州市，广州医科大学附属第一医院 广州呼吸健康研究院呼吸与危重症医学科 国家呼吸医学中心 国家呼吸系统疾病临床医学研究中心 呼吸疾病国家重点实验室
- 3. 510430 广东省广州市白云区石井街社区卫生服务中心计划免疫科
- 4. 510450 广东省广州市，广州市第一人民医院白云医院（广州市白云区第二人民医院）呼吸与危重症医学科
- 5. 510080 广东省广州市，广东省健康管理学会基层医疗及健康教育专业委员会
- 折叠
摘要
背景 随着慢性阻塞性肺疾病（COPD）正式纳入国家基本公共卫生服务项目，早期识别与标准化病例发现已成为管理工作的核心。县域医疗机构处于基层防控前沿，但面临筛查承载力不足的现实困境，开展全面无差别筛查易造成资源低效耗散。目的 探索适用于县域的住院患者COPD主动筛查优先级分层方案，以期提升筛查效率、节约筛查资源。方法 选取2023年12月—2024年10月广州市白云区西部医疗集团下属县域医院（广州市第一人民医院白云医院）的2 276例住院患者作为研究对象。患者入院后规范开展COPD-SQ筛查，对COPD-SQ评分阳性（≥16分）、存在COPD危险因素者行肺功能检查，进一步明确COPD诊断。通过医院信息系统（HIS）收集患者一般特征、疾病相关资料及COPD主动筛查资料。纳入年龄、COPD-SQ得分、是否有吸烟史、是否COPD-SQ筛查阳性、是否有慢性呼吸系统症状、完整诊断中是否包含常见合并症、是否完善肺功能检查、经肺功能检查是否确诊COPD共8个变量开展无监督聚类分析，对比不同类别患者的临床资料，挖掘潜在分组模式；再基于聚类得到的标签进行有监督分类分析，比较各组患者的COPD主动筛查结果，评价分组划分效果。结果 2 276例住院患者中，550例（24.17%）COPD-SQ筛查阳性，782例（34.36%）有吸烟史，725例（31.85%）有慢性呼吸系统症状，246例（10.81%）行肺功能检查，123例（5.40%）经肺功能检查确诊COPD。基于无监督聚类分析结果，综合考虑方法学逻辑、病因学逻辑与基层可操作性等，选取吸烟史、是否有慢性呼吸系统症状作为有监督分类标签，将住院患者划分为优先筛查组（n=311）、推荐筛查组（n=885）、暂缓筛查组（n=1 081）。优先筛查组的COPD-SQ筛查阳性比例、完善肺功能检查比例、经肺功能检查确诊COPD比例均最高，推荐筛查组次之，暂缓筛查组最低（P<0.017）。结论 可基于吸烟史与慢性呼吸系统症状对县域住院患者的COPD主动筛查优先级进行划分，并实施差异化筛查策略，但该方案仍需在更多临床场景中进一步验证应用效果。
Abstract
BackgroundAs chronic obstructive pulmonary disease (COPD) has been officially incorporated into the National Basic Public Health Service Program, early identification and standardized case finding have become the core of disease management. Although county-level medical institutions serve as the frontline of primary prevention and control, they face the challenge of insufficient screening capacity, and universal undifferentiated screening inevitably leads to inefficient dissipation of resources. ObjectiveTo explore a priority stratification scheme for active screening of COPD among inpatients in county-level hospitals, aiming to improve screening efficiency and conserve screening resources. MethodsA total of 2 276 hospitalized patients from a county-level hospital (Baiyun Hospital of Guangzhou First People's Hospital) affiliated with the Western Medical Group of Baiyun District, Guangzhou, between December 2023 and October 2024 were enrolled as study subjects. Upon admission, patients routinely underwent COPD-SQ screening. Those with a positive COPD-SQ score ( 16 points) and/or COPD risk factors were referred for pulmonary function testing to further confirm the COPD diagnosis. General patient characteristics, disease-related data, and active screening data were collected through the Hospital Information System (HIS). Eight variables were included for unsupervised clustering analysis: age, COPD-SQ score, smoking history, positive COPD-SQ screening result, presence of chronic respiratory symptoms, inclusion of common comorbidities in the complete diagnosis, completion of pulmonary function testing, and confirmed COPD diagnosis via pulmonary function testing. Clinical data were compared across different patient clusters to identify potential subgroup patterns. Subsequently, supervised classification analysis was performed based on the labels derived from clustering, and the active COPD screening outcomes were compared among groups to evaluate the grouping performance. ResultsAmong the 2,276 hospitalized patients, 550 (24.17%) had positive COPD-SQ screens, 782 (34.36%) had a smoking history, 725 (31.85%) had chronic respiratory symptoms, 246 (10.81%) underwent pulmonary function testing, and 123 (5.40%) were confirmed with COPD by pulmonary function testing. Based on the unsupervised clustering results and comprehensive consideration of methodological logic, etiological rationale, and grassroots operability, smoking history and presence of chronic respiratory symptoms were selected as the labels for supervised classification. The hospitalized patients were thus divided into a priority screening group (n=311), a recommended screening group (n=885), and a deferred screening group (n=1 081). The priority screening group had the highest proportions of positive COPD-SQ screening, completion of pulmonary function testing, and confirmed COPD diagnosis via pulmonary function testing, followed by the recommended screening group, with the deferred screening group showing the lowest proportions (P<0.017). ConclusionPriority stratification for active COPD screening among county-level hospital inpatients can be effectively based on smoking history and chronic respiratory disease symptoms, allowing for tailored screening strategies. However, the applicability of this scheme requires further validation in diverse clinical settings.关键词
肺疾病，慢性阻塞性/筛查/住院病人/县域医疗/吸烟Key words
Pulmonary disease/ chronic obstructive/Screening/Inpatients/County-level healthcare/Smoking引用本文复制引用
萧鲲,梁振宇,梁匡迪,李美怡,梁兰芳,许浦生.县域住院患者慢性阻塞性肺疾病主动筛查风险分层及优先级方案构建研究[EB/OL].(2026-11-09)[2026-11-11].https://chinaxiv.org/abs/202611.00094.学科分类
预防医学
