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慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是诱发慢性疾病死亡的危险疾病之一,COPD病人常伴其他疾病,而共患疾病是影响病人预后的主要因素,所以称为COPD相关共患疾病[1]。COPD病人的共患疾病较多,据不完全统计,95.9%的COPD病人伴一种或以上共患疾病,COPD普遍的共患疾病有心血管疾病(心力衰竭、心肌梗死、心律不齐、外周血管疾病、高血压)、骨质疏松、焦虑抑郁、肝癌、代谢综合征及糖尿病、胃食管反流、支气管扩张与睡眠呼吸综合征等,文献报道COPD病人死亡由共患疾病造成的占60%以上[2-3]。近年来,诊断COPD共患疾病评估常用Charlson合并症指数(Charlson comorbidity index,CCI),但共患疾病造成COPD病人急性加重风险的关系需进一步研究。本文旨在探讨COPD病人共患疾病的种类对COPD稳定期病人的预后价值。
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52例稳定期COPD病人mMRC评分为2(1,3)、CAT评分15(10,22);平均FEV1%为45.28%,平均FEV1/FVC为51.25%;入组前一年急性加重总次数2(1,2)次。随访过程中由于COPD急性加重出现死亡1例,所以针对51例COPD病人采取1年随访,病人平均门诊就诊次数0(0,1)次,急诊就诊次数0(0,0)次,住院次数0(0,1.65)次,总急性加重次数1(0,2)次。
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与低分组比较,高分组病人年龄大、FEV1%,且伴大量COPD相关共患疾病,在1年随访期间病人住院次数多(P < 0.05~P < 0.01)(见表 1)。
指标 低分组
(n=26)高分组
(n=25)uc P 年龄/岁 63.5±8.2 71.8±8.0 3.66△ <0.01 性别(男/女)/例 18/8 20/5 0.78□ >0.05 BMI/(kg/m2) 23.7±3.8 23.2±3.5 0.49△ >0.05 mMRC评分/分 2(1,2) 2(1,3) -1.62 >0.05 CAT评分/分 14(10,22) 17(11,20.5) -0.96 >0.05 (FEV1/FVC)/% 51.5±10.7 45.5±11.2 1.96△ >0.05 FEV1% 51.7±17.5 41.2±16.8 2.18△ <0.05 共患疾病数量 1(1,2) 3(3,6) -6.19 < 0.01 全身糖皮质激素使用的疗程/d 0(0,2) 1(0,2) -1.18 >0.05 抗生素使用疗程/d 2(1,2) 2(1,2) -0.76 >0.05 未预约门诊次数 0(0,0.5) 0(0,1) -0.61 >0.05 住院次数 0(0,0.5) 1(0,2) -2.03 <0.05 急性加重总次数 0.5(0,2) 2(0,3) -1.36 >0.05 △示t值; □示χ2值 表 1 临床资料与随访1年急性加重情况比较[中位数(四分位间距)]
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入组52例COPD病人伴COPD相关共患疾病数量超过3种27例(较多共患疾病组)。与较少共患疾病组比较,较多共患疾病组病人年龄大、mMRC评分高、FEV1%低、CCI评分与年龄校正后CCI评分高,随访过程中因COPD急性加重病人采用全身糖皮质激素与抗生素的疗程增加(P < 0.05~P < 0.01)。较少共患疾病组与较多共患疾病组随访期间未预约门诊次数、住院次数、急性加重总次数差异均无统计学意义(P>0.05)(见表 2)。
指标 较少共患疾病组
(n=24)较多共患疾病组
(n=27)uc P 年龄/岁 64.2±3.7 68.9±3.2 4.87△ < 0.01 性别(男/女)/例 16/8 22/5 1.47□ >0.05 BMI/(kg/m2) 23.1±2.7 23.5±2.6 0.54△ >0.05 mMRC评分/分 2(1,2) 2(1,2.5) -2.51 <0.05 CAT评分/分 14(10,19) 16.5(10.5,20) -1.18 >0.05 (FEV1/FVC)/% 52.9±10.5 48.6±10.1 1.49△ >0.05 FEV1%/% 52.7±18.6 41.6±14.8 2.37△ <0.05 CCI评分/分 1(1,1) 2(1,1.5) -4.28 < 0.01 年龄矫正后CCI评分/分 3(2,3) 5(3,5) -4.70 < 0.01 全身糖皮质激素使用的疗程/d 0(0,0.5) 1(0,2) -3.20 <0.01 抗生素使用疗程/d 1(1,2.5) 3(2,3) 3.62 < 0.01 未预约门诊次数 0(0,1) 0(0,1) 0.69 >0.05 住院次数 0(0,1) 0(0,1.5) -1.17 >0.05 急性加重总次数 0(0,2.5) 2(0,3) -1.69 >0.05 △示t值; □示χ2值 表 2 临床资料及随访期间急性加重情况比较[中位数(四分位间距)]
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伴支气管扩张COPD病人在随访阶段住院次数、急性加重总次数均高于无支气管扩张病人(P < 0.05),但COPD加重造成门诊与社区就诊、急诊次数差异无统计学意义(P>0.05);其余共患疾病尚未出现对未来急性加重风险影响(见表 3)。
共患疾病 门诊/
社区次数住院次数 急性加重总次数 高血压 有 1(0,2) 1(0,2) 2(0,2.5) 无 0(0,1) 0(0,1) 1(0,2) 代谢综合征及糖尿病 有 1(0,1) 1(0,1.75) 2(0,3.5) 无 1(0,1) 0(0,1) 1(0,2) 骨质疏松 有 0(0,1) 3(0,3) 2(1,4) 无 1(0,1) 0(0,1) 1(0,2) 支气管扩张 有 0.5(0,1.5) 2(0.5,3.8)* 3(1.7,4)* 无 0(0,1) 0(0,1) 1(0,2) 外周血管疾病 有 1(0,1) 0(0,1) 2(0,2) 无 0(0,1) 0(0,2) 1(0,2) 秩和检验:与无支气管扩张病人比较*P < 0.05 表 3 不同共患疾病与随访期间急性加重情况比较[中位数(四分位间距)]
COPD病人共患疾病的种类在COPD稳定期病人中的预后价值
The prognostic value of comorbidities disease in patients with stable COPD
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摘要:
目的探讨慢性阻塞性肺疾病(COPD)病人共患疾病的种类在COPD稳定期病人中的预后价值。 方法回顾性分析52例COPD稳定期病人临床资料,分析共患疾病情况与Charlson合并症指数(CCI),按照CCI评分分为高分组(25例)与低分组(26例),按共患疾病数分为较少共患疾病组(24例)与较多共患疾病组(27例),比较各组临床表现,观察共患疾病数量、种类与病人肺功能关系。 结果与低分组比较,高分组病人年龄大、FEV1占预计值百分比低,且伴大量COPD相关共患疾病,在1年随访期间病人住院次数多(P < 0.05~P < 0.01);与较少共患疾病组比较,较多共患疾病组病人年龄大、mMRC评分高、FEV1占预计值百分比低、CCI评分与年龄校正后CCI评分高,随访过程中因COPD急性加重病人采用全身糖皮质激素与抗生素的疗程增加(P < 0.05~P < 0.01);较少共患疾病组与较多共患疾病组随访期间急性加重总次数差异无统计学意义(P>0.05);伴支气管扩张COPD病人在随访期间住院次数、急性加重总次数均高于无支气管扩张病人(P < 0.05);但COPD加重造成门诊与社区就诊、急诊次数差异无统计学意义(P>0.05)。 结论COPD病人共患疾病类型、评估共患疾病程度对COPD病人全方面诊断与预后价值具有相关性。 Abstract:ObjectiveTo investigate the prognostic value of comorbidities in patients with stable chronic obstructive pulmonary disease(COPD). MethodsThe clinical data of 51 stable COPD patients were retrospectively analyzed, and the Charlson comorbidity index(CCI) was calculated.According to the CCI, patients were divided into high score group(n=25) and low score group(n=26).The patients were divided into the less co-morbidity group(n=24) and more co-morbidity group(n=27) according to co-morbidity numbers.The clinical characteristics, and correlation of number and type of comorbidities with pulmonary function were compared between two groups. ResultsCompared with the low score group, the age was older, the ratio of FEV1 accounting for expected value was lower, the number of COPD related comorbidities was larger, and the number of hospitalizations was more during 1 year following-up in high score group(P < 0.05 to P < 0.01).Compared with the less co-morbidity group, the age was older, the mMRC score was higher, the ratio of FEV1 accounting for expected value was lower, the CCI score and CCI score after adjusting age were higher, and the treatment course with systemic glucocorticoids and antibiotics because of the COPD acute exacerbating increased during the following-up in more co-morbidity group(P < 0.05 to P < 0.01).There was no statistical significance in the total number of acute exacerbation patients between less co-morbidity group and more co-morbidity group during the following-up(P>0.05).The number of hospital stays and total number of acute exacerbations in patients with COPD complicated with bronchiectasis were higher than those in patients without bronchiectasis(P < 0.05).However, there was no statistically significance among the number of outpatient and community visits, and emergency visits due to exacerbation of COPD(P>0.05). ConclusionsThe type and disease degree of comorbidities are correlation with the diagnosis and prognosis value in COPD patients. -
Key words:
- chronic obstructive pulmonary disease /
- comorbidity /
- stable stage /
- prognosis
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表 1 临床资料与随访1年急性加重情况比较[中位数(四分位间距)]
指标 低分组
(n=26)高分组
(n=25)uc P 年龄/岁 63.5±8.2 71.8±8.0 3.66△ <0.01 性别(男/女)/例 18/8 20/5 0.78□ >0.05 BMI/(kg/m2) 23.7±3.8 23.2±3.5 0.49△ >0.05 mMRC评分/分 2(1,2) 2(1,3) -1.62 >0.05 CAT评分/分 14(10,22) 17(11,20.5) -0.96 >0.05 (FEV1/FVC)/% 51.5±10.7 45.5±11.2 1.96△ >0.05 FEV1% 51.7±17.5 41.2±16.8 2.18△ <0.05 共患疾病数量 1(1,2) 3(3,6) -6.19 < 0.01 全身糖皮质激素使用的疗程/d 0(0,2) 1(0,2) -1.18 >0.05 抗生素使用疗程/d 2(1,2) 2(1,2) -0.76 >0.05 未预约门诊次数 0(0,0.5) 0(0,1) -0.61 >0.05 住院次数 0(0,0.5) 1(0,2) -2.03 <0.05 急性加重总次数 0.5(0,2) 2(0,3) -1.36 >0.05 △示t值; □示χ2值 表 2 临床资料及随访期间急性加重情况比较[中位数(四分位间距)]
指标 较少共患疾病组
(n=24)较多共患疾病组
(n=27)uc P 年龄/岁 64.2±3.7 68.9±3.2 4.87△ < 0.01 性别(男/女)/例 16/8 22/5 1.47□ >0.05 BMI/(kg/m2) 23.1±2.7 23.5±2.6 0.54△ >0.05 mMRC评分/分 2(1,2) 2(1,2.5) -2.51 <0.05 CAT评分/分 14(10,19) 16.5(10.5,20) -1.18 >0.05 (FEV1/FVC)/% 52.9±10.5 48.6±10.1 1.49△ >0.05 FEV1%/% 52.7±18.6 41.6±14.8 2.37△ <0.05 CCI评分/分 1(1,1) 2(1,1.5) -4.28 < 0.01 年龄矫正后CCI评分/分 3(2,3) 5(3,5) -4.70 < 0.01 全身糖皮质激素使用的疗程/d 0(0,0.5) 1(0,2) -3.20 <0.01 抗生素使用疗程/d 1(1,2.5) 3(2,3) 3.62 < 0.01 未预约门诊次数 0(0,1) 0(0,1) 0.69 >0.05 住院次数 0(0,1) 0(0,1.5) -1.17 >0.05 急性加重总次数 0(0,2.5) 2(0,3) -1.69 >0.05 △示t值; □示χ2值 表 3 不同共患疾病与随访期间急性加重情况比较[中位数(四分位间距)]
共患疾病 门诊/
社区次数住院次数 急性加重总次数 高血压 有 1(0,2) 1(0,2) 2(0,2.5) 无 0(0,1) 0(0,1) 1(0,2) 代谢综合征及糖尿病 有 1(0,1) 1(0,1.75) 2(0,3.5) 无 1(0,1) 0(0,1) 1(0,2) 骨质疏松 有 0(0,1) 3(0,3) 2(1,4) 无 1(0,1) 0(0,1) 1(0,2) 支气管扩张 有 0.5(0,1.5) 2(0.5,3.8)* 3(1.7,4)* 无 0(0,1) 0(0,1) 1(0,2) 外周血管疾病 有 1(0,1) 0(0,1) 2(0,2) 无 0(0,1) 0(0,2) 1(0,2) 秩和检验:与无支气管扩张病人比较*P < 0.05 -
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