老年慢性阻塞性肺疾病患者肺部感染流行病学特征及风险预测

Epidemiological characteristics and risk prediction of pulmonary infection in elderly patients with chronic obstructive pulmonary disease

目的 探究老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者肺部感染流行病学特征,并构建风险预测模型。方法 以2020年5月至2022年6月125例老年COPD患者为研究对象,统计感染患者的流行病学特征,对患者并发症肺部感染的危险因素进行分析,并构建预测模型。结果 125例老年COPD患者中肺部感染者46例,感染率为36.80%,其中革兰氏阴性菌的检出率大于革兰氏阳性菌及真菌(64.44%vs 33.33%、2.22%,P<0.05);吸烟史、合并糖尿病、机械通气、不合理使用抗生素、合并低蛋白血症是影响老年COPD患者并发肺部感染的危险因素(P<0.05);经多元logistic回归分析得到老年COPD患者并发肺部感染的预测模型,PI=-1.981+0.657X_(吸烟史)+0.806X_(合并糖尿病)+0.521X_(机械通气)+0.639X_(不合理使用抗生素)+0.715X_(合并低蛋白血症)。Hosmer-Lemeshow检验显示,Hosmer-Lemeshow χ2=0.812,P=0.295;经ROC曲线分析得,预测模型预测老年COPD患者并发肺部感染的AUC值为0.802。结论 老年COPD患者并发肺部感染的致病菌以革兰氏阴性菌为主,根据影响患者出现肺部感染的危险因素构建的预测模型对患者并发肺部感染具有预测价值。

Objective To explore the epidemiological characteristics of pulmonary infection in elderly patients with chronic obstructive pulmonary disease(COPD),and to construct a risk prediction model.Methods Among of 125 elderly patients with COPD from May 2020 to June 2022 were selected as the research subjects.The epidemiological characteristics of infected patients were counted,and the risk factors of pulmonary infection in patients were analyzed and a prediction model was constructed.Results A total of the 125 elderly patients with COPD,there were 46 cases of pulmonary infection,with the infection rate of 36.80%.The detection rate of Gram-negative bacteria was higher than that of Gram-positive bacteria or fungi(64.44%vs 33.33%or 2.22%,P<0.05).Smoking history,presence of diabetes mellitus,mechanical ventilation,irrational use of antibiotics,and hypoalbuminemia were risk factors for pulmonary infection in elderly patients with COPD(P<0.05).Prediction model of pulmonary infection in elderly patients with COPD obtained by multivariate logistic regression analysis was shown as PI=-1.981+0.657×smoking history+0.806×presence of diabetes mellitus+0.521×mechanical ventilation+0.639×irrational use of antibiotics+0.715×presence of hypoalbuminemia.Hosmer-Lemeshow test showed that Hosmer-Lemeshow χ2=0.812 and P=0.295.ROC curve analysis revealed that the AUC value of the prediction model on predicting the pulmonary infection in elderly patients with COPD was 0.802.Conclusion The Pathogenic bacteria of elderly patients with COPD complicated with pulmonary infection are mainly Gram-negative bacteria.The prediction model constructed according to the risk factors of pulmonary infection in patients has predictive value on pulmonary infection in patients.