影响慢性阻塞性肺疾病急性加重患者住院病死率的危险因素

Risk factors for in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨影响慢性阻塞性肺疾病急性加重（AECOPD）患者住院期间病死率的危险因素。方法回顾性分析南方医院呼吸与危重症医学科2010年1月至2012年8月因AECOPD住院治疗的182例患者的临床资料。搜集和分析患者一般资料、稳定期情况、肺功能、血常规、血气分析、C反应蛋白（CRP）等指标，对影响患者预后的危险因素进行Logistic多因素回归分析。结果182例患者中死亡42例，好转140例。死亡组患者中稳定期综合评估急性加重风险高、低外周血淋巴细胞计数、高CRP、合并贫血、低蛋白血症、高碳酸血症、慢性肺源性心脏病、缺血性心脏病方面的所占比例分别为90．4％、73．8％、50．O％、50．0％、71．4％、64．3％、76．1％、19．0％，好转组分别为70．0％、47．1％、17．1％、27．1％、46．4％、30．7％、40．7％、7．O％，组间差异均有统计学意义（均P〈0．05）。高CRP（OR=3．226，P=0．009）、高碳酸血症（OR=2．928，P=0．013）、慢性肺源性心脏病（OR=2．510，P=0．045）、低外周血淋巴细胞计数（OR=2．488，P=0．045）是影响AECOPD患者住院期间死亡的独立危险因素。结论低外周血淋巴细胞、高CRP、高碳酸血症、慢性肺源性心脏病是影响AECOPD患者住院期间死亡的独立危险因素。

Objective To explore the risk factors for hospitalization case fatality of patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A retrospective review of medical records was performed for 182 hospitalized AECOPD patients at Nanfang Hospital from January 2010 to August 2012. Their general information, condition in stable stage, the results of spirometry, blood routine test, blood gas analysis and C-reactive protein （CRP） were collected and analyzed. The risk factors for mortality were analyzed by muhivariable Logistic regression. Results Among them, 42 died during hospitalization. Univariate analysis revealed that 8 factors had significant differences between two groups （ all P 〈 0. 05 ） ： high exacerbation risk （ death vs improvement group, 90. 4% vs 70. 0% ） , low peripheral absolute lymphocyte count （73.8% vs 47. 1% ） , high CRP （50. 0% vs 17.1% ） , concurrent anemia （50. 0% vs 27.1% ）, hypoproteinemia （71.4% vs 46.4% ）, hypereapnia （64. 3% vs 30. 7% ）, chronic pulmonary heart disease （76. 1% vs 40. 7% ） and ischemic heart disease （19.0% vs 7.0% ）. By multiple Logistic regression analysis, high CRP （ OR = 3. 226, P = 0. 009 ） , hypereapnia （ OR = 2. 928, P = 0. 013 ）, chronic pulmonary heart disease （ OR = 2. 510, P = 0. 045 ） , low peripheral absolute lymphocyte count （OR = 2. 488, P = 0. 045 ） were the independent risk factors for hospitalization case fatality of AECOPD patients. Conclusion Low peripheral absolute lymphocyte count, high CRP, hypercapnia and chronic pulmonary heart disease were the independent risk factors for mortality in hospitalized AECOPD patients.