湖南省尘肺病患者再入院危险因素分析

Analysis of risk factors for readmission of pneumoconiosis patients in Hunan

目的探讨尘肺病患者再入院的危险因素,为提高尘肺病治疗效果、降低再入院率和减少疾病负担提供科学依据。方法于2020年6月,回顾性分析湖南省职业病防治院2014年2月至2020年2月有住院记录的470例尘肺病患者的临床资料,通过问卷和电话随访收集第一次入院时患者的一般资料和情绪状况。患者至少完成1次随访,以再入院为终点事件。用Kaplan-Meier法进行单因素分析,对有统计学意义的变量进行多因素COX回归模型分析,探讨影响患者再入院的危险因素。结果共纳入尘肺病患者470例,平均年龄55.88(34~81)岁,均为男性。第一次出院诊断为叁期尘肺病患者215例(45.74%);第一次出院诊断为尘肺病合并慢性阻塞性肺疾病患者179例(38.09%),合并脂肪肝患者51例(10.85%);肺弥散功能重度障碍患者44例(9.36%),有6例(1.28%)患者自患病以来几乎每天都有自杀倾向。再入院患者共345例(73.40%)。多因素COX回归模型分析结果显示,与疑尘肺组比较,壹期、贰期、叁期尘肺组患者再入院风险增加(OR=2.43、2.96、2.35,P<0.05);与发病年龄为30~50岁组比较,发病年龄50~70岁、≥70岁组患者再入院的风险增加(OR=1.28、2.32,P<0.05);与正常组比较,三尖瓣返流的尘肺病患者、高甘油三酯组(>2.26 mmol/L)尘肺病患者、尘肺病肺弥散功能重度障碍患者再入院风险均增加(OR=1.33、1.40、1.96,均P<0.05);与患病以来完全没有自杀倾向组比较,几乎每天都有自杀倾向组尘肺病患者再入院风险增加(OR=2.92,P<0.05)。结论发病年龄、尘肺期别、三尖瓣返流、高甘油三酯、重度肺弥散功能障碍以及自杀倾向为影响尘肺病患者再入院的独立危险因素。应加强对尘肺病人相关慢性疾病和心理健康的管理,以降低再入院危险。

Objective To explore the risk factors of pneumoconiosis patients're-admission to provide a scientific basis for improving the treatment effect of pneumoconiosis,reducing the rate of re-admission,and reducing the burden of disease.Methods In June 2020,The clinical data of 470 patients with pneumoconiosis who had hospitalization records from February 8,2014,to February 8,2020,in the Hunan Provincial Occupational Disease Prevention and Treatment Institute were retrospectively analyzed.The patients'general data and emotional state at the first admission were collected through questionnaires and telephone follow-ups.The entire group of patients completed at least one follow-up,with readmission as the end event.First,the Kaplan-Meier method was used for univariate analysis.The multivariate COX regression model analysis was performed on meaningful variables to explore the risk factors that affect the patient's re-admission.Results A total of 470 patients with pneumoconiosis were included in this study,with an average age of 55.88 years(34-81 years old)and all the participants were male.During the first admission,the number of participants diagnosed as stage III pneumoconiosis,with complications of COPD,fatty liver,or severe pulmonary diffusion dysfunction was 215(45.74%),179(38.09%),51(10.85%),and 44(9.36%),respectively.Six patients(1.28%)have had suicidal tendencies almost every day since they became ill.A total of 345 patients(73.40%)were re-admitted to the hospital.Multivariate Cox regression model analysis showed that compared with the suspected pneumoconiosis group,patients in the first,second,and third-stage pneumoconiosis groups had an increased risk of readmission(OR=2.43,2.96,2.35,P=0.000).Compared with the age of 30-50 years old,50-70 years old and≥70 years old have an increased risk of readmission(OR=1.28,2.32,P<0.05).Patients with tricuspid regurgitation(OR=1.33,P<0.05)and elevated triglyceride level(>2.26 mmol/L)(OR=1.40,P<0.05)have increased risks of readmission.Compared with the normal group,patients with severe pulmonary diffusion dysfunction in pneumoconiosis have an increased risk of readmission(OR=1.96,P<0.05).Compared with the normal group,pneumoconiosis patients in the suicidal group had an increased risk of re-admission to the hospital almost every day(OR=2.92,P<0.05).Conclusion Age of onset,stage of pneumoconiosis,tricuspid regurgitation,high triglycerides,severe diffuse pulmonary dysfunction,and suicidal tendency are independent risk factors that affect the readmission of patients with pneumoconiosis.The management of chronic diseases and mental health of patients with pneumoconiosis should be strengthened to reduce the risk of readmission.Conclusion Age of onset,stage of pneumoconiosis,tricuspid regurgitation,high triglycerides,severe diffuse pulmonary dysfunction,and suicidal tendency are independent risk factors that affect the readmission of patients with pneumoconiosis.The management of chronic diseases and the mental health of patients with pneumoconiosis should be strengthened to reduce the risk of readmission.