营养不良和25羟维生素D及白介素1β与老年住院患者发生慢性阻塞性肺疾病的关系研究

Correlation of Malnutrition,25-hydroxy Vitamin D and Interleukin-1βwith Chronic Obstructive Pulmonary Disease in Elderly Inpatients

背景目前,慢性阻塞性肺疾病(COPD)的具体发病机制仍不十分清楚,临床干预以药物控制肺部症状为主,而关于COPD肺外相关因素的影响尚未引起足够重视。目的分析营养不良、25羟维生素D[25(OH)D]及白介素1β与老年住院患者发生COPD的关系。方法选取2020年11月至2021年8月云南省第一人民医院老年医学科新入院患者305例,根据COPD发生情况分为非COPD组216例和COPD组89例。比较两组患者一般资料和老年综合评估项目;老年住院患者发生COPD的影响因素分析采用二元Logistic回归分析,营养不良、25(OH)D、白介素1β与老年住院患者发生COPD的相关性分析采用Spearman秩相关分析。结果两组患者年龄、性别、当前吸烟率、营养状况、认知功能、焦虑状态发生率、抑郁状态发生率、失能发生率、睡眠状况、衰弱状况、多重用药比例、用药种数、血小板计数、C反应蛋白、总蛋白、白蛋白、甲状腺素、25(OH)D、雌二醇、睾酮、凝血酶原时间、D-二聚体、白介素6、白介素1β比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,当前吸烟[OR=2.351,95%CI(1.053,5.249)]、潜在营养不良[OR=2.429,95%CI(1.118,5.276)]、营养不良[OR=3.936,95%CI(1.355,11.439)]、失眠[OR=2.584,95%CI(1.094,6.102)]、C反应蛋白[OR=0.988,95%CI(0.978,0.999)]、25(OH)D[OR=0.929,95%CI(0.880,0.981)]、白介素1β[OR=1.025,95%CI(1.003,1.047)]是老年住院患者发生COPD的独立影响因素(P<0.05)。Spearman秩相关分析结果显示,营养不良(r_(s)=0.280,P<0.001)、白介素1β(r_(s)=0.145,P=0.011)与老年住院患者COPD的发生呈正相关,而25(OH)D与老年住院患者COPD的发生呈负相关(r_(s)=-0.264,P<0.001)。结论营养不良、25(OH)D、白介素1β是老年住院患者发生COPD的独立影响因素,其中营养不良、白介素1β与老年住院患者COPD的发生呈正相关,而25(OH)D与老年住院患者COPD的发生呈负相关。

Background The specific pathogenesis of chronic obstructive pulmonary disease(COPD)is still not very clear so far,clinical interventions mainly focus on the control of pulmonary symptoms with drugs,however,the influence of extrapulmonary related factors of COPD has not caused enough attention.Objective To explore the correlation of malnutrition,25-hydroxy vitamin D and interleukin-1βwith COPD in elderly inpatients.Methods A total of 305 inpatients(≥60 years old)were recruited from Department of Geriatrics,the First People's Hospital of Yunnan Province from November 2020 to August 2021,and divided into COPD group(n=89)and non-COPD group(n=216)according to the incidence of COPD.General information and comprehensive geriatric assessment results were compared between the two groups;binary Logistic regression analysis was used to analyze the influencing factors of COPD in elderly inpatients,and Spearman rank correlation analysis was used to analyze the correlation of malnutrition,25-hydroxy vitamin D and interleukin-1βwith COPD.Results There were significant differences in age,gender,current smoking rate,nutritional status,cognitive function,incidence of anxiety and depression,incidence of disability,sleeping status,frailty status,proportion of multiple drugs,kinds of drugs used,platelet count,C-reactive protein,total protein,albumin,thyroxine,25-hydroxy vitamin D,estradiol,testosterone,prothrombin time,D-dimer,interleukin-6 and interleukin-1βbetween the two groups(P<0.05).The results of binary Logistic regression analysis showed that,current smoking[OR=2.351,95%CI(1.053,5.249)],underlying malnutrition[OR=2.429,95%CI(1.118,5.276)],malnutrition[OR=3.936,95%CI(1.355,11.439)],sleeplessness[OR=2.584,95%CI(1.094,6.102)],C-reactive protein[OR=0.988,95%CI(0.978,0.999)],25-hydroxy vitamin D[OR=0.929,95%CI(0.880,0.981)]and interleukin-1β[OR=1.025,95%CI(1.003,1.047)]were independent influencing factors of COPD in elderly inpatients(P<0.05).The results of Spearman rank correlation analysis showed that,malnutrition(r_(s)=0.280,P<0.001)and interleukin-1β(r_(s)=0.145,P=0.011)were positively correlated with the incidence of COPD in elderly inpatients,while 25-hydroxy vitamin D was negatively correlated with the incidence of COPD(r_(s)=-0.264,P<0.001).Conclusion Malnutrition,25-hydroxy vitamin D and interleukin-1βare independent influencing factors of COPD in elderly inpatients.Among them,malnutrition and interleukin-1βare positively correlated with the incidence of COPD,while 25-hydroxy vitamin D is negatively correlated with the incidence of COPD.