慢性阻塞性肺疾病急性加重并发糖尿病的危险因素分析

Risk factors for acute exacerbation of chronic obstructive pulmonary disease complicated with diabetes

目的探讨慢性阻塞性肺疾病急性加重并发糖尿病(AECOPD-DM)的临床特点及危险因素,寻找潜在的AECOPD-DM的预测指标,为干预AECOPD病情进展及合并症管理提供参考。方法收集盘锦市中心医院2019年9月1日至2021年5月1日因AECOPD住院的患者,根据是否合并糖尿病分为单纯AECOPD组为对照组(n=150)和AECOPD-DM组为试验组(n=131),比较2组患者的一般资料、血糖水平、炎症指标、凝血指标、血气指标、血脂指标、合并疾病。应用Logistic回归分析AECOPD-DM的危险因素,绘制受试者工作特征(ROC)曲线分析各指标对AECOPD-DM的诊断效能。结果试验组白细胞、C-反应蛋白(CRP)、D二聚体(D-Dimer)、纤维蛋白原(FIB)、二氧化碳分压(PaCO_(2))低密度脂蛋白胆固醇(LDL-C)均高于对照组(P<0.05);凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、氧分压(PaO_(2))、动脉血氧饱和度(SaO2)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)均低于对照组(P<0.05)。高血压、LDL-C是AECOPD并发DM的危险因素,PaO_(2)、APTT、TC是AECOPD并发DM的保护因素。这5个因素联合指标ROC曲线下面积0.976(95%CI:0.964~0.989,P<0.001)高于糖化血红蛋白(HbA1C)的ROC曲线下面积为0.895(95%CI:0.854~0.935,P<0.001),敏感度为98.5%,特异度为83.3%。结论AECOPD-DM发病机制及危险因素复杂,预后较差,早期预测指标能够指导临床早期识别与管理AECOPD-DM患者,对改善患者预后,加强慢病管理、减轻社会经济负担起到积极作用。

Objective To investigate the clinical characteristics and risk factors of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with diabetes mellitus(DM),and to identify potential predictors of AECOPD complicated with DM,in order to provide reference for the intervention of AECOPD disease progression and complication management.Methods Patients who were hospitalized with AECOPD at Panjin Central Hospital from September 1,2019 to May 1,2021 were collected and divided into either a control group(patients with AECOPD alone;n=150)or an experimental group(patients with AECOPD combined with DM;n=131)according to whether they had DM.The general information,blood glucose level,inflammation indexes,coagulation indexes,blood gas indexes,blood lipid indexes,and concomitant diseases were compared between the two groups.Logistic regression was used to identify the risk factors for AECOPD complicated with DM,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of each index for AECOPD with DM.Results The white blood cell count,C-reactive protein,D-dimer,fibrinogen,carbon dioxide partial pressure,and low-density lipoprotein cholesterol(LDL-C)in the experimental group were significantly higher than those of the control group(P<0.05),while the prothrombin time,partially activated prothrombin time(APTT),oxygen partial pressure(PaO_(2)),arterial oxygen saturation,triglycerides,total cholesterol(TC),and high-density lipoprotein cholesterol were all significantly lower than those of the control group(P<0.05).Hypertension and LDL-C were identified to be risk factors for AECOPD with DM,while PaO_(2),APTT,and TC were identified to be protective factors for AECOPD complicated with DM.The area under the ROC curve(AUC)of the combined index of these five factors was 0.976(95%CI:0.964~0.989,P<0.001),which was higher than that of glycated hemoglobin(AUC=0.895,95%CI:0.854~0.935,P<0.001),with a sensitivity of 98.5%and specificity of 83.3%.Conclusion The pathogenesis and risk factors of AECOPD with DM are complex,and the prognosis is poor.Early prediction indicators can guide early clinical identification and management of AECOPD patients with DM,and play a positive role in improving patient prognosis,strengthening chronic disease management,and reducing social and economic burden.