慢性阻塞性肺疾病频繁急性加重患者的临床特征分析

Clinical Characteristics of Patients with Chronic Exacerbation of Chronic Obstructive Pulmonary Disease

目的观察慢性阻塞性肺疾病(COPD)频繁急性加重患者与非频繁急性加重患者临床特征的差异。方法回顾性纳入2016年1月~2018年12月合肥市第一人民医院呼吸内科住院的274例COPD急性加重患者,根据患者上一年急性加重次数分为频繁组(住院次数≥2次/年)143例和非频繁组(住院次数<2次/年)131例,比较两组性别、年龄、病程、吸烟量、mMRC评分、共患疾病(高血压、冠心病、糖尿病)、白细胞计数、中性粒细胞百分比、淋巴细胞百分比、嗜酸粒细胞百分比、降钙素原(PCT)、血气指标(pH、PaO2、PaCO2)及血氧饱和度(SpO2),多因素Logistic回归分析COPD频繁急性加重的危险因素。结果两组性别、年龄、白细胞计数、淋巴细胞百分比、嗜酸粒细胞百分比、PCT、pH、PaCO2、共患疾病(高血压、冠心病、糖尿病)比较,差异无统计学意义(P>0.05);频繁组病程、吸烟量、mMRC评分、中性粒细胞百分比、SpO2、PaO2均高于非频繁组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,病程、吸烟量、mMRC评分、中性粒细胞百分比是COPD频繁急性加重的独立危险因素。结论COPD频繁急性加重多病程较长,患者多长期吸烟,临床中应重视病程长、吸烟量大、mMRC评分高、中性粒细胞百分比高的COPD患者,加强对其的监护管理,防止发生COPD频繁急性加重。

Objective To observe the clinical features of patients with frequent exacerbation of chronic obstructive pulmonary disease(COPD)and patients with infrequent acute exacerbations.Methods Retrospectively included 274 patients with acute exacerbations of COPD who were admitted to the Department of Respiratory Medicine of Hefei First People's Hospital from January 2016 to December 2018.According to the number of patients with acute exacerbations in the previous year,143 patients in the frequent group(number of hospitalizations≥2 times/year)and 131 patients in the non-frequent group(number of hospitalizations<2 times/year)were compared.Compare gender,age,duration of disease,smoking,mMRC score,comorbidity(hypertension,coronary heart disease,diabetes),white blood cell count,percentage of neutrophils,percentage of lymphocytes,percentage of eosinophils,calcium reduction prime factors(PCT),blood gas indicators(pH,PaO2,PaCO2)and oxygen saturation(SpO2),multivariate Logistic regression analysis of risk factors for frequent acute exacerbations of COPD.Results There were no significant differences in gender,age,white blood cell count,percentage of lymphocytes,percentage of eosinophils,PCT,pH,PaCO2,comorbidity(hypertension,coronary heart disease,diabetes)between the two groups(P>0.05).The frequent course,smoking,mMRC score,neutrophil percentage,SpO2,PaO2 were higher than the non-frequent group,the difference was statistically significant(P<0.05);multivariate Logistic regression analysis showed that the course of disease,smoking,the mMRC score and the percentage of neutrophils are independent risk factors for frequent acute exacerbations of COPD.Conclusion Frequent acute exacerbation of COPD has a long course of disease.Patients with long-term smoking should pay attention to patients with COPD who have long course of disease,high smoking,high score of mMRC and high percentage of neutrophils in clinical practice,strengthen the monitoring and management of it to prevent frequent acute exacerbations of COPD.