上海浦东地区非吸烟老年慢性阻塞性肺疾病患者急性加重的影响因素研究

Influencing Factors of Acute Exacerbation in Non-smoking COPD Elderly in Pudong area, Shanghai

目的分析上海浦东地区非吸烟老年慢性阻塞性肺疾病(COPD)患者急性加重的影响因素,为防治该病提供依据。方法选择124例COPD患者,根据发作频率分为3组:COPD无急性加重组、非频发COPD急性加重组和频发COPD急性加重组。采用现况研究设计的方法分析并比较3组的临床资料;应用单因素及多因素Logistic回归分析并确定导致COPD频繁急性加重的影响因素。结果3组年龄、病程、血清CRP、家族史、规律锻炼史及哮喘史具有显著差异(P<0.05);而性别比例的差异无统计学意义(P>0.05);多因素回归分析显示频发COPD急性加重与哮喘病史以及血清CRP含量密切相关(P<0.05);3组使用多嗦茶碱和短效M受体激动剂的疗效差异无统计学意义(P>0.05),而吸入性糖皮质激素、全身用糖皮质激素、长效受体激动剂和白三烯受体激动剂在频发COPD急性加重组中的疗效显著高于其余2组(P<0.05)。结论非吸烟COPD患者发生急性加重较常见,对于具有哮喘史、SGRQ评分增加以及血清CRP含量升高的COPD患者应重点关注其频繁急性加重的可能性,针对性做好规范化诊治及健康宣教。

Objective To explore the influencing factors of acute exacerbation of chronic obstructive pulmonary diseases (COPD) in non-smoking elderly in Pudong area,Shanghai so as to provide the basis for prevention and treatment. Methods 124 cases with COPD were divided,according to the attack frequency,into 3 groups: COPD group with no acute exacerbation,COPD group with acute exacerbation but no frequent attack and COPD group with both acute exacerbation and frequent attack;prevalence study was applied in analyzing and comparing the clinical data of the cases in the 3 groups while univariate and multiple logistic regression analysis were performed to determine the influencing factors leading to acute exacerbation and frequent attack of COPD.Results There existed an obvious difference in age,disease course,serum CRP, family history,regular exercise history and asthma occurence (P<0.05) but no statistical difference in sex among the 3 groups (P>0.05);multiple logistic regression analysis indicated that COPD with both acute exacerbation and frequent attack and asthma occurrence history were in close correlation with the serum CPR content (P<0.05);the curative effects of doxofylline and short-acting muscarinic receptor agonist were of no statistical difference (P>0.05) while the application of inhaled glucocorticoids,systemic glucocorticoids,long-acting beta-receptor agonists and leukotriene receptor agonists was of greater curative effect in COPD group with both acute exacerbation and frequent attack than in the other 2 groups (P<0.05).Conclusions Acute exacerbation is common in non-smoking COPD cases;attention should be paid to the occurrence possibility of acute exacerbation of COPDwith frequent attacks in COPDcases with asthma occurrence history,higher scores of St George's respiratory questionnaire (SGRQ) and elevated serum CRP content;standard diagnosis and treatment,as well as health education,should be provided..