老年慢性阻塞性肺疾病进展为哮喘-慢性阻塞性肺疾病重叠综合征的临床特征及风险因素分析

Analysis of clinical characteristics and risk factors of COPD developing into ACOS in elderly patients

目的分析老年慢性阻塞性肺疾病(COPD)患者进展为哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)临床特征变化及其危险因素。方法选取中国人民解放军西部战区总医院2019年1月—2022年1月收治的125例COPD患者,回顾性分析其临床资料,其中94例单纯COPD为对照组,31例COPD进展为ACOS为观察组,比较2组一般资料、临床症状体征、发作诱因、肺功能指标以及相关临床指标等差异,并使用Logistic分析导致老年COPD进展为ACOS的危险因素。结果2组一般情况[过敏史、哮喘史、气道高反应性(AHR)]、症状体征(气促、咳嗽咳痰、单纯哮鸣音、干湿啰音)、肺部感染、肺功能[第1秒用力呼气容积占预计值百分比(FEV1%prep)、用力肺活量(FVC)、FEV1/FVC水平]以及相关临床指标[免疫球蛋白E(IgE)、白细胞计数(WBC)、嗜酸性粒细胞数量、呼出气一氧化氮(FeNO)、白细胞介素-6(IL-6)、肿瘤坏死因子-(TNF-)以及C反应蛋白(CRP)]差异有统计学意义(P<0.05),观察组肺功能明显降低,过敏反应、气道炎症反应以及全身炎症反应明显增强;哮喘史、AHR以及FeNO是导致老年COPD进展为ACOS的独立危险因素(P<0.05),方差膨胀系数(VIF)均<3。结论老年COPD进展为ACOS临床症状、体征以及相关临床指标与单纯COPD患者有所差异,哮喘史、AHR以及FeNO水平升高可能增加老年COPD患者进展为ACOS风险。

Objective To analyze the clinical characteristics and risk factors of chronic obstructive pulmonary disease(COPD)developing into asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS)in elderly patients.Methods The clinical data of 125 patients with COPD admitted to General Hospital of Western Theater Command of Chinese People’s Liberation Army from January 2019 to January 2022 was retrospectively analyzed.Among them,94 patients with simple COPD were included in the control group,and 31 ones with COPD developing into ACOS were included in the observation group.The differences of general data,clinical symptoms and signs,attack inducements,lung function indexes and related clinical indexes were compared between the two groups.Logistic analysis was used to analyze the risk factors for COPD developing into ACOS in the elderly.Results There were statistically significant differences between the two groups in the general information[allergic history,asthma history,airway hyperresponsiveness(AHR)],symptoms and signs(shortness of breath,cough and expectoration,simple wheezing,dry and moist rales),FEV1%pred,forced vital capacity(FVC),FEV1/FVC]and related clinical indexes[immunoglobulin E(IgE),white blood cell count(WBC),eosinophil count,fractional exhaled nitric oxide(FeNO),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)](P<0.05).The lung function of the observation group decreased significantly,and the allergic reaction,airway inflammatory reaction and systemic inflammatory reaction increased significantly.Asthma history,AHR and FeNO were independent risk factors for COPD developing into ACOS in the elderly(P<0.05),and the variance inflation coefficient(VIF)<3.Conclusion The clinical symptoms,signs and related clinical indexes of elderly patients with COPD developing into ACOS are different from those with simple COPD.Asthma history,increased AHR and FeNO level may increase the risk of COPD developing into ACOS in the elderly.