慢性阻塞性肺疾病频繁急性加重的危险因素

Risk factors for frequent acute exacerbations of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(COPD)频繁急性加重的相关危险因素。方法本研究为病例对照研究。采用非随机对照法选择从2012年1月到2022年1月因COPD急性加重在兰州大学第一医院住院治疗的515例患者为研究对象,频繁急性加重组183例,非频繁急性加重组332例。收集患者急性加重期一般临床资料及肺功能、血气分析、血液学等多个指标,采用多因素logistic回归分析COPD频繁急性加重的危险因素。结果频繁急性加重组COPD病程、残总比、动脉血二氧化碳分压、中性粒细胞百分比、中性粒细胞绝对值、红细胞分布宽度(RDW)、D-二聚体均高于非频繁急性加重组(均P<0.05)。而频繁急性加重组用力肺活量(FVC)、FVC占预计值百分比(FVC%pred)、第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值百分比(FEV_(1)%pred)、FEV_(1)/FVC、一氧化碳弥散量(D_(L)CO)、单位肺泡容积一氧化碳弥散量(D_(L)CO/VA)、动脉血氧分压、血氧饱和度、淋巴细胞百分比、淋巴细胞绝对值均低于非频繁急性加重组(均P<0.05)。logistic回归分析显示,低FEV_(1)%pred(OR=0.99,95%CI:0.98~1.00,P=0.006),低D_(L)CO(OR=0.88,95%CI:0.80~0.98,P=0.014),合并Ⅰ型呼吸衰竭(OR=2.06,95%CI:1.27~3.34,P=0.003)、Ⅱ型呼吸衰竭(OR=2.61,95%CI:1.24~5.49,P=0.012),RDW升高(OR=1.15,95%CI:1.03~1.28,P=0.010)是COPD频繁急性加重的危险因素。结论阻塞性肺通气功能障碍、弥散功能严重受损,合并呼吸衰竭,RDW升高是COPD频繁急性加重的主要危险因素,临床上应早期识别并及早干预,减少COPD急性加重的发生。

Objective To explore the hazards of frequent acute exacerbations of chronic obstructive pulmonary disease(COPD).Methods This was a case-control study.A total of 515 patients with acute exacerbation of COPD in the First Hospital of Lanzhou University from January 2012 to January 2022 were selected as subjects by non-randomized control method,including 183 patients with frequent acute exacerbations and 332 patients with infrequent acute exacerbations.General clinical data,pulmonary function,blood gas analysis,hematology,and other indicators were collected,and the risk factors of COPD frequent acute exacerbation were analyzed by multivariate logistic regression.Results The duration of COPD,residual volume to total lung capacity,arterial partial pressure of carbon dioxide,neutrophils ratio,neutrophils count,red cell distribution width(RDW),and D-dimer in frequent acute exacerbations of COPD group were all significantly higher than those in infrequent acute exacerbations of COPD group(all P<0.05).In addition,forced vital capacity(FVC),FVC%pred,the first second forced expiratory volume(FEV_(1)),FEV_(1)%pred,FEV_(1)/FVC,diffusing capacity of the lung for carbon monoxide(D_(L)CO),diffusing capacity of the lung for carbon monoxide to volume alveolar(D_(L)CO/VA),arterial blood oxygen partial pressure,arterial oxygen saturation,lymphocyte percentage,and lymphocyte count in frequent acute axacerbations of COPD group were all lower than those in infrequent acute exacerbations of COPD group(all P<0.05).Logistic regression analysis showed that low FEV_(1)%pred(OR=0.99,95%CI:0.98-1.00,P=0.006),low D_(L)CO(OR=2.06,95%CI:1.27-3.34,P=0.003),and typeⅠrespiratory failure(OR=2.06,95%CI:1.27-3.34,P=0.003),typeⅡrespiratory failure(OR=2.61,95%CI:1.24-5.49,P=0.012),and increased RDW(OR=1.15,95%CI:1.03-1.28,P=0.010)were the risk factors for frequent exacerbations of COPD.Conclusions Obstructive pulmonary ventilation dysfunction,severely impaired diffusion function,combined with respiratory failure,and elevated RDW are the main risk factors for frequent acute exacerbations of COPD.Early clinical indentification and intervention should be carried out to reduce the occurrence of acute exacerbations of COPD.