COPD的肺康复治疗与肺炎发生的相关性分析

Analysis of the Correlation Between Lung Rehabilitation Therapy and Pneumonia in Patients with COPD

目的:目前认为,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者接受吸入糖皮质激素(ICS)治疗,肺炎的风险增加。进行肺康复治疗(PR)的慢性阻塞性肺疾病患者没有肺炎发生相关的危险数据。方法:在2年,我们回顾分析2组COPD患者:接受PR治疗和未接受PR治疗的患者。第一组包括58例接受PR治疗的患者,其中40例接受ICS治疗,18例仅接受支气管扩张剂治疗。第二组由27例COPD患者接受ICS治疗,而不进行PR治疗的患者。疑似肺炎的诊断,均用胸部X光片确认。结果:总的来说,第一组肺炎患者1例,1例接受ICS患者,0例仅用支气管扩张剂治疗患者。这相当于分别为2.5%和0%的比率。7.4%例COPD患者未经PR治疗,显著高于首次研究组(P=0.00)。组。结论:COPD患者肺炎的发生率明显降低。使用ICS和PR治疗的COPD患者肺炎的发生率明显低于仅适用于ICS治疗而不进行PR治疗的患者。在大量的PR治疗的慢性阻塞性肺疾病患者,需要多中心队列研究,这种观察值得研究。

Objective:Based on meta-analyses results,it is currently acknowledged that there is an increased risk of pneumo-nia in patients with chronic obstructive pulmonary disease(COPD)undergoing inhaled corticosteroids(ICS)treat-ment.However,this is not found to be true in those with asthma.No data on this risk are available for COPD patients involved in pulmonary rehabilitation program(PR).Methods:For 15 months,we prospectively studied 2 cohorts of COPD patients-undergoing PR and not undergoing PR.The first group included 58 patients undergoing PR of which 40 were treated with ICS,and 18 were treated with bronchodilators only.The second group was comprised of 27 COPD patients who were treated with ICS,but not PR.The diagnosis of pneumonia,when suspected,had to be confirmed with a chest x-ray.Results:Overall,1 cases of pneumonia were diagnosed in the first study group:1 ICS-treated patients and 0 patient treated only with bronchodilators.This corresponded to a rate of 2.5 and 0%,respectively,compared to a rate of 7.4%in COPD patients not treated with PR,which was significantly higher(P=0.00)thaii that in the first study group.No case of pneumonia was registered among patients with asthma.Conclusion:These findings suggest that a signifcantly lower incidence of pneumonia is found in COPD patients treated with ICS and PR than in patients treated with ICS but not with PR.This observation deserves to be investigated in large populations of PR-treated COPD patients,possibly in multi-centric cohort studies.