慢性阻塞性肺疾病稳定期患者病情急性加重的影响因素分析

Influencing Factors for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Stable Phase Patients

目的 探讨稳定期慢性阻塞性肺疾病(COPD)患者病情急性加重的影响因素。方法 前瞻性选取2019年1月至2021年1月新乡市中心医院收治的接受三联治疗的稳定期COPD患者104例作为研究对象,经治疗后随访观察12个月,根据有无急性加重分为加重组和未加重组。收集两组患者入组时人口社会学特征、肺功能、纤维蛋白原(FIB)水平等;采用多因素二元logistic回归分析COPD急性加重的影响因素,绘制受试者工作特征(ROC)曲线评价影响因素对三联治疗稳定期COPD患者急性加重风险的预测性能。结果 随访观察12个月,因搬迁、死亡失访2例,最终纳入102例,其中43例(42.17%)病情急性加重归为加重组,其余59例(57.84%)未出现急性加重归为未加重组。两组入院时慢阻肺评估测试问卷(CAT评分)、第1秒用力呼气末容积(FEV_(1))、血清C反应蛋白(CRP)、血浆FIB水平对比差异有统计学意义(P<0.05);多因素logistic回归分析显示:高CAT评分、高CRP水平、高FIB水平为三联治疗稳定期COPD患者急性加重风险的危险因素(P<0.05),高FEV_(1)水平则为三联治疗稳定期COPD患者急性加重风险的保护因素(P<0.05)。ROC曲线显示,FIB预测稳定期COPD患者急性加重风险的曲线下面积(AUC)高于CAT、FEV_(1)及CRP。结论 FIB水平可有效预测三联治疗的稳定期COPD患者急性加重风险。

Objective To explore the influencing factors of acute exacerbation in patients with stable chronic obstructive pulmonary disease(COPD).Methods A prospective study was conducted on 104 stable COPD patients admitted to Xinxiang Central Hospital from January 2019 to January 2021 who received triple therapy as the study objects.After treatment,they were followed up for 12 months and were divided into plus or without recombination based on acute exacerbation.The demographic and sociological characteristics,lung function,and fibrinogen(FIB)levels of patients in the two groups at the time of enrollment were collected.Multiple factor binary logistic regression was used to analyze the influencing factors of acute exacerbation of COPD,and receiver operating characteristic(ROC)curve was drawn to evaluate the predictive performance of influencing factors on the risk of acute exacerbation in stable COPD patients treated with triple therapy.Results During the 12-month follow-up observation,2 cases were lost to follow-up due to relocation or death.Finally,102 cases were included,of which 43 cases(42.17%)were classified as reorganized with acute exacerbation,and the remaining 59 cases(57.84%)without acute exacerbation were classified as unreinforced reorganization.There were statistical differences in COPD assessment test questionnaire(CAT score),forced end-expiratory volume in one second(FEV_(1)),serum C-reactive protein(CRP)and plasma FIB levels between the two groups at admission(P<0.05).Multivariate logistic regression analysis showed that high CAT score,high CRP level,high FIB level were the risk factors for acute exacerbation risk in stable COPD patients with triple therapy(P<0.05),and high FEV_(1) level was the risk factor for triple therapy in stable COPD patients protective factors of acute exacerbation risk(P<0.05).ROC curve showed that in stable COPD patients,the area under curve(AUC)of FIB was higher than that of CAT,FEV_(1) and CRP.Conclusion FIB levels can effectively predict the risk of acute exacerbation in stable COPD patients receiving triple therapy.