慢性阻塞性肺疾病急性加重与慢性阻塞性肺疾病合并社区获得性肺炎的差异性研究

Differences between acute exacerbation of COPD and COPD complicated with community acquired pneumonia

目的比较慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并社区获得性肺炎(community acquired pneumonia,CAP)之间的差异,为这两类患者的诊治提供依据。方法收集广州医科大学附属第三医院呼吸内科2013-01~2015-08收治的COPD 251例患者的临床资料,根据病史及肺部影像学是否存在渗出病灶,将患者分为AECOPD组(157例)及COPD合并肺炎组(94例)。比较两组年龄、入院时BMI、血红蛋白、白蛋白、C-反应蛋白、白细胞、中性粒细胞百分比、血气分析、肺功能之间的差异。根据患者出院时的存活状态分为存活组和死亡组,比较两组患者的死亡率。结果 AECOPD组157例中,死亡7例;COPD合并肺炎组94例中,死亡12例,COPD合并肺炎组病死率高于AECOPD组(OR=3.13,95%CI=1.19~8.26)。COPD合并肺炎组平均年龄、中性白细胞百分比、C-反应蛋白及二氧化碳分压高于AECOPD组,而BMI、白蛋白、血红蛋白及氧分压低于AECOPD组。与AECOPD组相比,COPD合并肺炎组有更多的患者合并有冠心病(P<0.05)。两组患者的吸烟状况、肺功能没有明显差别(P>0.05)。结论 COPD合并肺炎组病死率高于AECOPD组,其有更多的冠心病合并症,炎性标志物更高,营养状态更差,二氧化碳潴留及缺氧更严重。

Objective To investigate the differences between acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and chronic obstructive pulmonary disease(COPD)complicated with community acquired pneumonia(CAP).Methods The clinical data of COPD patiens were collected in our department from January 2013 to August 2015.According to the results of case history and chest X-ray examinations,all the patients were divided into two groups:AECOPD group and COPD complicated with CAP(COPD-CAP)group.The age,white blood cell count,hemoglobin(HB),albumin(ALB)and inflammatory markers and the proportion of neutrophils,body mass index(BMI),lung function,C-reactive protein(CRP),blood gas analysis and the in-hospital mortality were compared between the two groups.Results 251 COPD patients were included in the study,including 157 AECOPD patients and 94 COPD-CAP patients.The in-hospital mortality of the COPD-CAP group was higher than that of the AECOPD group(OR=3.13,95%CI=1.19~8.26).The average age of the COPD-CAP group was older than that of the AECOPD group[(78.0±8.3)vs(73.7±9.4)years,P<0.001].The proportion of neutrophils and the levels of CRP and PaCO 2 in the COPD-CAP group were higher than those in the AECOPD group.The levels of BMI,ALB,HB and PaO 2 in the COPD-CAP group were lower than those in the AECOPD group.The COPD-CAP group had more patients coexisting with coronary heart disease.There were no differences between the two groups in smoking status and lung function.Conclusion The patients with COPD complicated with CAP are prone to have poorer nutritional status,higher levels of inflammatory markers,more complications of coronary heart disease,poorer blood gas analysis and higher in-hospital mortality in those with AECOPD.