慢性阻塞性肺疾病合并糖尿病患者临床特点及相关因素分析

Analysis on the related factors and clinical characteristics of chronic obstructive pulmonary disease with diabetes mellitus patients

目的研究慢性阻塞性肺疾病(COPD)合并糖尿病(DM)患者临床特点及相关因素,为制定疾病预防及干预措施提供依据。方法选取2014年2月至2016年2月在四川大学华西医院呼吸内科住院接受治疗的132例COPD合并DM患者为COPD合并DM组。选择同期在该院接受治疗的132例COPD未合并DM患者为对照组。对两组患者进行肺功能检查、血清炎症因子水平测定,收集疾病并发症以及患者药物治疗时间。用SPSS 13.0软件对数据进行χ2检验和t检验,并用logistic回归分析COPD合并DM的相关因素。结果治疗前COPD合并DM组肺功能中的1秒用力呼气容积(FEV1)/预计值、用力肺活量(FVC)/预计值以及FEV1/FVC水平均明显低于对照组,差异均有统计学意义(P<0.01),而COPD合并DM组血清中C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均明显高于对照组,差异均有统计学意义(P<0.01);COPD合并DM组2种及以上致病菌、Ⅱ型呼吸衰竭、肺源性心脏病所占比例、抗生素使用时间、激素治疗时间均高于对照组,差异均有统计学意义(P<0.01)。多因素logistic回归分析结果显示,肺功能异常、炎症水平、致病菌、Ⅱ型呼吸衰竭、肺源性心脏病、抗生素治疗时间以及激素治疗时间对COPD合并DM有影响(OR值分别为2.581、3.382、2.108、2.728、3.083、2.557和1.613,P<0.01)。结论应关注临床治疗中COPD合并DM患者的肺功能状况、炎症反应情况、致病菌感染情况和抗生素、激素治疗时间,控制并发症发生。

Objective To explore the related factors of clinical characteristics of chronic obstructive pulmonary disease （COPD） with diabetes mellitus （DM）, and to provide the evidence for prevention and control measures. Methods From February 2014 to February 2016, 132 inpatients of COPD with DM and 132 inpatients of COPD in West China hospital of Sichuan university served as the subject group and control group, respectively. The pulmonary function and serum inflammation factor levels were measured in two groups, and the data of complications or drug treatment time of two groups were collected. The X2 test and t test were used to analyze all data with SPSS 13.0 software, the logistic regression method was used to analyze the influencing factors of COPD with DM. Results Before the treatment, the levels of FEV1,FVC and FEV1/FVC in the lung function of the subject group were significantly lower than those in the control group （P〈0.01）, but the serum IL-6 and CRP levels in the subject group were significantly higher than those in the control group （P〈0.01）. The proportions of two acute pathogenic bacteria, type II respiratory failure, pulmonary heart disease, antibiotic treatment time and hormone treatment time in the subject group were significantly higher than those in the control group （P〈0.01）. The multivariate logistic regression analysis displayed that the pulmonary function abnormality, inflammation level, pathogen, type II respiratory failure, pulmonary heart disease, antibiotic treatment time and hormone treatment time were influencing factors of COPD with DM （OR values were 2.581, 3.382, 2.108, 2.728, 3.083, 2.557 and 1.613, respectively, P〈0.01 ）. Conclusion In treatment of COPD with DM, the pulmonary function, inflammation level, pathogen, antibiotic treatment time and hormone treatment time should be observed and the complications should be controlled.