既往吸入糖皮质激素对合并慢性阻塞性肺病的社区获得性肺炎住院患者预后的影响

Impact of Prior Use of Inhaled Corticosteroids on the Clinical Outcomes of Obstructive Pulmonary Disease Patients Hospitalised with Community-Acquired Pneumonia

【目的】探讨既往吸入糖皮质激素(IC)对合并慢性阻塞性肺病(COPD)的社区获得性肺炎(CAP)住院患者临床结局的影响。【方法】这是一个多中心、回顾性研究。收集于2013年1月1日至2016年12月31日在北京山东和云南5家教学医院住院的所有合并慢性阻塞性肺病的社区获得性肺炎(COPD-CAP)患者的病例资料。比较既往使用和不使用IC的患者,包括人口学资料、临床和影像学特征以及支持治疗和临床结局。用logis?tic回归探讨IC使用史对COPD-CAP患者临床结局的影响。【结果】共有725例COPD-CAP住院患者纳入最后分析,有IC使用史的占13.9%(101/725)。相比于无IC使用史的COPD-CAP患者,既往使用IC的患者合并心血管病(19.8%vs 12.7%)和1年内曾有CAP住院史(20.8%vs 11.2%)的比例高;出现胸水(13.9%vs 23.7%)比例低;属于慢性阻塞性肺病全球创议(GOLD)2期(10.4%vs 51.0%)比例低,而属于GOLD 3期(35.1%vs 22.9%)和4期(51.9%vs 21.8%)的比例高。经过年龄、性别、基础病、CURB-65评分、PSI分级和GOLD分期调整的logistic回归分析证实:既往使用IC与COPD-CAP患者无创机械通气风险降低有关[OR=0.220,95%CI(0.052,0.926),P=0.029],但是与有创机械通气[OR=0.290,95%CI(0.068,1.236),P=0.094]、需要使用血管活性药物[OR=1.261,95%CI(0.456,3.485),P=0.655]、入住ICU[OR=1.455,95%CI(0.638,3.320),P=0.373]和30 d病死率[OR=1.650,95%CI(0.575,2.838),P=0.352]无关。【结论】既往使用IC对COPD-CAP患者的临床结局无重大影响。

【Objective】To evaluate the impact of prior use of inhaled corticosteroids(IC)on the clinical outcomes of chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia(COPD-CAP).【Methods】This was a multicenter,retrospective study.Data of COPD-CAP patients from five teaching hospitals in Bei?jing,Shandong and Yunnan Provinces during 1st January 2013 through 31th December 2016 were reviewed.The patients with and without prior use of IC were compared,including demographic characteristics,clinical and radiologic features,and outcomes.A logistic regression model was conducted to explore the impact of prior IC use on the clinical outcomes of COPD-CAP patients.【Results】Of 725 patients included in the study,13.9%(101/725)were prior IC users.Compared with no-IC users,IC users showed higher frequency of cardiovascular comorbidity(19.8%vs 12.7%)and a CAP history in the last year(20.8%vs 11.2%);lower occurrence of pleural effusion(13.9%vs 23.7%);more often classified in Global Initiative for Chronic Obstructive Lung Disease(GOLD)stage 3(35.1%vs 22.9%)and GOLD 4 stage(51.9%vs 21.8%),less often in GOLD 2 stage(10.4%vs 51.0%).Adjusted by age,gender,underlying diseases,PSI/CURB-65 score and GOLD stage,logistic regression analysis confirmed prior IC use was associated with decreased risk for noninvasive ventila?tion[OR=0.220,95%CI(0.052,0.926),P=0.029],but not with invasive ventilation[OR=0.290,95%CI(0.068,1.236),P=0.094],needing vasopressor use[OR=1.261,95%CI(0.456,3.485),P=0.655],ICU admission[OR=1.455,95%CI(0.638,3.320),P=0.373]and 30-day mortality[OR=1.650,95%CI(0.575,2.838),P=0.352].【Conclusion】Previous IC use has no major impact on the clinical outcomes of COPD-CAP patients.