慢性阻塞性肺疾病急性加重风险相关因素的研究

Study on Factors Related to the Risk of Acute Exacerbations of Chronic Obstructive Pulmonary Diseases

目的分析慢性阻塞性肺疾病(以下简称慢阻肺)急性加重风险的相关因素,探讨降低急性加重风险的相应措施。方法根据患者FEV1%Pred、稳定期mMRC评分、过去一年急性加重次数和住院史,分为高风险组和低风险组。比较两组临床特征及相关实验室结果的差异,分析与慢阻肺急性加重风险相关的因素。结果高风险组有吸烟史及使用ICS的患者比例、呼吸道病毒检测阳性率和稳定期CAT评分高于低风险组;但高风险组BMI、FEV1%Pred、外周血嗜酸粒细胞比例及CD8+细胞比例低于低风险组。分析显示,吸烟史、CAT评分、FEV1%Pred、使用ICS、呼吸道病毒感染和外周血CD8+细胞比例可能与慢阻肺急性加重风险相关;使用ICS、呼吸道病毒感染为急性加重高风险的相关因素。结论慢阻肺急性加重高风险患者平时更多地使用ICS,且对呼吸道病毒更为易感。

OBJECTIVE To analyze the factors related to the risk of acute exacerbation of COPD and to explore the corresponding mea⁃sures to reduce the risk of acute exacerbations.METHODS Patients were divided into high-risk group and low-risk group according to FEV1%Pred mMRC scores in stable stage,the times of acute exacerbation and hospitalization in the past 1 year.The differences of clinical characteristics and laboratory results between groups were compared,and the factors related to the risk of acute exacerbations of COPD were analyzed.RESULTS The proportion of patients with smoking history and using ICS,the positive rate of respiratory vi⁃rus detection,and the CAT score in the stable phase in the high-risk group were higher than the low-risk group.However,the BMI,FEV1%Pred,peripheral blood eosinophil ratio,and CD8^+cell ratio in the high-risk group were lower than those in the low-risk group.Univariate logistic regression analysis show smoking,CAT scores,FEV1%Pred,using ICS,respiratory viral infection and the pro⁃portion of CD8^+cells in peripheral blood may be related to the risk of acute exacerbation of COPD.And using ICS and respiratory vi⁃ral infection were related factors of high risk of acute exacerbation due to multivariate logistic regression analysis.CONCLUSION Pa⁃tients with high risk of acute exacerbation usually need to use more ICS,and were more susceptible to respiratory viral infections.