慢性阻塞性肺疾病合并阿尔茨海默病患者肺部感染的危险因素及预后评估

Risk factors for pulmonary infection in patients with chronic obstructive pulmonary disease complicated with Alzheimer′s disease and its prognosis evaluation

目的探讨慢性阻塞性肺疾病(COPD)合并阿尔茨海默病(AD)患者住院期间发生肺部感染的危险因素及改良虚弱指数(mFI)对预后的评估价值。方法回顾性选取解放军总医院第二医学中心神经内科COPD合并AD且发生了肺部感染的患者80例,设为感染组;选取COPD合并AD但未发生肺部感染的患者80例,设为非感染组。再根据患者在住院期间的存活或死亡情况,将160例患者分入死亡组(11例)和存活组(149例)。收集研究所需要的各项信息,包括N末端B型脑钠肽前体(NT-proBNP)、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)水平等,计算mFI评分。采用Logistic回归分析探讨COPD合并AD患者肺部感染及预后的影响因素,绘制受试者工作特征曲线(ROC),计算ROC曲线下面积(AUC)、敏感度、特异度和最佳截断值。结果感染组患者的吸烟构成比以及NT-proBNP、CysC、hs-CRP、PCT、mFI水平均高于非感染组患者(P<0.05)。死亡组患者NT-proBNP、CysC、hs-CRP、PCT、mFI水平均高于存活组患者(P<0.05)。Logistic回归分析结果显示,NT-proBNP、hs-CRP、mFI是COPD合并AD患者肺部感染、死亡的独立影响因素(P<0.05)。mFI评分评估COPD合并AD患者肺部感染与预后的灵敏度、特异度分别为80.06%、59.38%和85.65%、72.53%。结论mFI是COPD合并AD患者出现肺部感染及预后情况的独立预测因素,具有较高的临床评估价值,可作为预测COPD合并AD患者住院期间出现肺部感染和预后情况的指标。

OBJECTIVE To explore the risk factors for pulmonary infection in patients with chronic obstructive pulmonary disease(COPD)and Alzheimer′s disease during hospitalization and the value of modified frailty index(mFI)in evaluating prognosis.METHODS Total of 80 patients with COPD complicated with AD and pulmonary infection in the department of neurology,the Second Medical Center,PLA General Hospital were retrospectively selected as the infection group,and 80 patients with COPD complicated with AD without pulmonary infection were selected as the non-infection group.According to the outcomes of the patients,160 patients were divided into the death group(11 cases)and the survival group(149 cases).The information required for the study were collected,including N-terminal precursor B-type brain natriuretic peptide(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT)levels,etc.,and the mFI score was calculated.Logistic regression analysis was used to evaluate the influencing factors for pulmonary infection and prognosis in patients with COPD and AD.The receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve(AUC),sensitivity,specificity and optimal cut-off value.RESULTS The proportion of smoking and the levels of NT-proBNP,CysC,hs-CRP,PCT and mFI in the infection group were higher than those in the non-infection group(P<0.05).The levels of NT-proBNP,CysC,hs-CRP,PCT and mFI in the death group were higher than those in the survival group(P<0.05).Logistic regression analysis showed that NT-proBNP,hs-CRP and mFI were independent influencing factors of pulmonary infection and death in COPD patients with AD(P<0.05).The sensitivity and specificity of mFI score for the evaluation of pulmonary infection and prognosis of COPD patients with AD were 80.06%,59.38%and 85.65%,72.53%,respectively.CONCLUSION MFI is an independent predictor for pulmonary infection and poor prognosis in patients with COPD and AD,which has high clinical evaluation value,and can be used as an indicator to predict the occurrence of pulmonary infection and prognosis of patients with COPD and AD during hospitalization.