住院慢性阻塞性肺疾病急性加重合并原发性高血压患者的临床特征分析

Study on the clinical features of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease combined with hypertension

目的探讨住院慢性阻塞性肺疾病急性加重(AECOPD)合并原发性高血压患者的临床特征。方法本研究为横断面研究。采用非随机抽样法,选取遂宁市第一人民医院2020年1月至2021年6月的住院AECOPD患者359例。根据排除和入选标准,最后纳入AECOPD患者267例,其中未合并原发性高血压患者163例,合并原发性高血压患者104例。收集和记录患者一般资料、基础疾病、肺功能、血常规、感染指标、血气分析及肝肾功能等数据。首先对数据进行单因素分析和共线性分析,然后对差异变量建立二元logistic回归模型,并采用Nomogram及相关曲线进行验证和可视化。结果单因素分析显示,与AECOPD未合并原发性高血压患者相比较,AECOPD合并原发性高血压患者的年龄更大[68(62,74)岁比73(67,78)岁,Z=3.75,P<0.001],体质量指数更高[(21.93±3.17)kg/m2比(23.12±3.16)kg/m2,t=2.99,P=0.003],冠状动脉粥样硬化性心脏病(CAD)(9.2%比30.8%,χ^(2)=20.36,P<0.001)和2型糖尿病(8.6%比23.1%,χ^(2)=10.92,P=0.001)发生率更高,血白细胞(WBC)[(8.04±3.12)×109/L比(8.86±3.38)×109/L,t=2.03,P=0.044]、血中性粒细胞(NS)[4.92(3.68,7.27)×109/L比6.00(4.26,8.06)×109/L,Z=2.43,P=0.015]、血肌酐(Cr)[71.00(58.00,87.70)μmol/L比77.60(65.92,96.00)μmol/L,Z=3.04,P=0.002]、降钙素原[(0.18±0.35)μg/L比(0.27±0.47)μg/L,t=1.65,P=0.099]及C反应蛋白(CRP)[(23.20±34.77)g/L比(31.62±42.78)g/L,t=1.76,P=0.079]水平均显著升高。进一步分析发现WBC与NS存在显著共线性(特征根为0.005,条件指数为23.096)。因此,排除WBC保留NS后,共纳入8个变量建立二元logistic回归方程(C指数为0.734),显示年龄(OR=1.04,P=0.023)、体质量指数(OR=1.12,P=0.012)、CAD(OR=3.21,P=0.002)、CRP(OR=1.01,P=0.059)及Cr(OR=1.01,P=0.066)与原发性高血压相关。采用Nomogram对二元logistic回归结果进行验证和可视化,效应曲线的平均绝对误差为0.026,受试者工作特征曲线的曲线下面积为0.724,提示该模型具有良好的预测一致性和准确性。DCA曲线显示Nomogram的风险阈值在0.09~0.89时该模型的预测净获益>0,提示有较好的临床预测价值。结论高龄、肥胖、合并CAD、更易合并肾功能不全及更严重的炎症反应是AECOPD合并原发性高血压患者的主要临床特征。因此,在对AECOPD合并原发性高血压患者的诊治过程中应积极完善CAD、肾功能不全及感染等合并症的相关检查,并给予对应的治疗。

Objective To explore the clinical features of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with hypertension.Methods It was a cross-sectional study involving 359 hospitalized AECOPD patients in Suining First People′s Hospital who were non-randomly enrolled from January 2020 to June 2021.Finally,a total of 267 eligible AECOPD were recruited,involving 104 combined with primary hypertension and 163 without.Demographic data,underlying diseases,lung function,blood routine,procalcitonin(PCT),C-reaction protein(CRP),arterial blood gas(ABG),liver and renal functions data were collected.Variables were first analyzed by univariate analysis and collinearity test,followed by binary logistic regression analysis on factors with significant differences in univariate analysis,which were further validated and visualized by nomogram and its associated curves.Results Univariate analysis revealed that AECOPD patients combined with primary hypertension had significantly older age(68[62,74]years vs 73[67,78]years,Z=3.75,P<0.001),larger body mass index(BMI)([21.93±3.17]kg/m2vs[23.12±3.16]kg/m2,t=2.99,P=0.003),higher proportion of coronary artery disease(CAD)(9.2%vs 30.8%,χ^(2)=20.36,P<0.001)and type 2 diabetes mellitus(8.6%vs 23.1%,χ^(2)=10.92,P=0.001),and higher blood white blood cell count(WBC)([8.04±3.12]×109/L vs[8.86±3.38]×109/L,t=2.03,P=0.044),blood neutrophil count(NS)(4.92[3.68,7.27]×109/L vs 6.00[4.26,8.06]×109/L,Z=2.43,P=0.015),creatinine(Cr)(71.00[58.00,87.70]μmol/L vs 77.60[65.92,96.00]μmol/L,Z=3.04,P=0.002),PCT([0.18±0.35]μg/L vs[0.27±0.47]μg/L,t=1.65,P=0.099),and C-reactive protein(CRP)([23.20±34.77]g/L vs[31.62±42.78]g/L,t=1.76,P=0.079)compared to those without hypertension.A strong collinearity was observed between WBC and NS(Eigenvalue=0.005,Condition index=23.096),and therefore,WBC was excluded and NS was included into the binary logistic regression model with the remaining 7 factors(C-index=0.734).These results showed that age(OR=1.04,P=0.023),BMI(OR=1.12,P=0.012),CAD(OR=3.21,P=0.002),CRP(OR=1.01,P=0.059),and Cr(OR=1.01,P=0.066)were independently correlated with hypertension in AECOPD patients.Additionally,the results were visualized and validated by nomogram,with the mean absolute error=0.026 in calibration curve and AUC=0.724 in ROC curve,suggesting that the model had good predictive consistency and accuracy.Meanwhile,decision curve analysis(DCA)curve showed that the net benefit was above 0 when the threshold ranged from 0.09 to 0.89,indicating an acceptable prognostic potential of the nomogram.Conclusions Taken together,the results indicated that the elderly,obesity,combined with CAD and renal dysfunction and severe inflammatory response are the main clinical features of AECOPD patients combined with hypertension.Therefore,examinations on CAD,renal function,and infection should be timely performed in AECOPD patients combined with hypertension,thus giving to corresponding interventions.