矽肺合并慢性阻塞性肺疾病患病率和危险因素分析

Prevalence and risk factors of silicosis complicated with chronic obstructive pulmonary disease

目的探讨矽肺患者合并慢性阻塞性肺疾病(COPD)的患病率、临床特征及两种疾病合并的危险因素。方法于2021年5月,采用横断面研究的方法,回顾性纳入2007年1月1日至2020年12月31日在北京朝阳医院首次诊断的矽肺患者,共329例,分析矽肺合并COPD患者的人口学资料、职业史、胸部影像、肺功能和血常规指标,用多元logistics回归分析矽肺合并COPD的危险因素。结果矽肺合并COPD患者共128例,总体患病率为38.9%(128/329)。其中,73.4%(94/128)为男性,33.6%(43/128)为重度吸烟者;33.6%(43/128)患者为《慢性阻塞性肺疾病全球倡议分级》(GOLD)1级,37.5%(48/128)为GOLD 2级,25.0%(32/128)为GOLD 3级,3.9%(5/128)为GOLD 4级。诊断年龄(OR=1.04,95%CI=1.02~1.06,P<0.001)、累积吸烟量(OR=1.03,95%CI=1.01~1.05,P=0.008)以及矽肺叁期(OR=7.06,95%CI:4.00~12.46,P<0.001)是矽肺合并COPD的危险因素。结论诊断年龄、累积吸烟量和矽肺叁期是矽肺患者合并不同程度COPD的危险因素,临床治疗中需加以关注。

Objective To explore the prevalence,clinical characteristics and risk factors of chronic obstructive pulmonary disease(COPD)in silicosis patients.Methods In May 2021,a cross-sectional study was used to retrospectively include 329 silicosis patients first diagnosed in Beijing Chaoyang Hospital from January 1,2007 to December 31,2020.The demographic data,occupational history,chest imaging,pulmonary function and blood routine indicators of silicosis patients with COPD were analyzed,and the risk factors of silicosis with COPD were analyzed by multiple logistic regression.Results There were 128 patients with silicosis complicated with COPD,and the overall prevalence rate was 38.9%(128/329).Among them,73.4%(94/128)were male and 33.6%(43/128)were heavy smokers;33.6%(43/128)of patients were classified as gold 1,37.5%(48/128)as gold 2,25.0%(32/128)as gold 3,and 3.9%(5/128)as gold 4.Diagnostic age(OR=1.04,95%CI=1.02~1.06,P<0.001),cumulative smoking(OR=1.03,95%CI=1.01~1.05,P=0.008)and silicosis stage III(OR=7.06,95%CI=4.00-12.46,P<0.001)were risk factors for silicosis complicated with COPD.Conclusion Diagnostic age,cumulative smoking volume and third stage of silicosis are the risk factors of silicosis patients with different degrees of COPD,which should be paid attention to in clinical treatment.