慢性阻塞性肺疾病急性加重期患者病原菌分布及死亡危险因素的Logistic分析

Logistic analysis of pathogenic bacteria distribution and risk factors of death in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者病原菌分布及住院期间病死率的危险因素。方法选取涿州市医院收治的重症AECOPD痰培养阳性患者192例,回顾性分析患者的病原菌分布特征、临床资料及实验室检查等,并对影响患者死亡的危险因素进行单因素及多因素Logistic回归分析。结果 192例痰培养阳性患者共分离出病原菌236株,其中革兰阴性杆菌173株(73.31%),革兰阳性球菌35株(14.83%),真菌28株(11.86%)。192例患者中死亡45例,存活147例。单因素分析显示,年龄、低淋巴细胞绝对计数、贫血、高碳酸血症、COPD综合评估分级、低清蛋白、高乳酸、高C反应蛋白(CRP)与AECOPD患者住院期间发生死亡显著相关(P均<0.05)。多元Logistic回归分析发现低淋巴细胞绝对计数、高乳酸、高CRP是AECOPD患者住院期间死亡的独立危险因素,其OR及95%CI分别为1.873(1.014,4.457)、1.624(0.715,4.218)、2.576(1.624,5.056)。ROC曲线评价Logistic回归模型效果的曲线下面积(AUC)及95%CI为0.892(0.813,0.975)。结论 AECOPD患者检出病原菌以革兰阴性杆菌居多,低淋巴细胞绝对计数、高乳酸、高CRP是AECOPD患者住院期间死亡的独立危险因素。

Objective It is to investigate the distribution of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease（ AECOPD） and the risk factors of mortality during hospitalization. Methods 192 cases of patients with severe AECOPD and positive sputum culture were selected and their pathogenic bacteria distribution characteristics,clinical data and laboratory tests were retrospectively analyzed,and the single factor and multi-factor Logistic regression analysis were carried out on the risk factors of death. Results A total of 236 pathogenic bacteria were isolated from 192 sputum cultures,including 173 gram negative bacilli（ 73. 31%）,35 strains of gram positive bacteria（ 14. 83%） and 28 strains of fungi（ 11. 86%）. In 192 cases of patients 45 cases died and 147 cases survived. Univariate analysis showed that age,low absolute lymphocyte count,anemia,hypercapnia,COPD comprehensive evaluation grade,low albumin,high lactic acid,high CRP were significantly related with the death of AECOPD patients during hospitalization（ P〈0. 05）. Multivariate logistic regression analysis showed that low absolute lymphocyte count,high lactic acid and high CRP were the independent risk factors for hospital mortality in patients with AECOPD,its OR and 95% CI were 1. 873（ 1. 014,4. 457）,1. 624（ 0. 715,4. 218）,2. 576（ 1. 624,5. 056）. The area under the curve（ AUC） and 95% CI were 0. 892（ 0. 813,0. 975） on the effect of the Logistic regression model by the ROC curve. Conclusion The majority of AECOPD patients are detect by Gram negative bacilli,and low absolute lymphocyte count,high lactic acid and high CRP are the independent risk factors for the death of AECOPD patients during hospitalization.