代谢综合征与慢性阻塞性肺疾病之间的关系

Relationship Between Metabolic Syndrome and Chronic Obstructive Pulmonary Disease

目的 探讨慢阻肺急性加重期(AECOPD)患者合并不同代谢综合征组分数量的临床特征及出现Ⅱ型呼吸衰竭的危险因素。方法 回顾性分析2014年1月至2017年12月福建省立医院吸科收治的249例AECOPD患者的病历资料。根据代谢综合征(MS)合并数量将患者分为4组。对比4组间患者的临床差异特征。借助logistic回归分析对发生Ⅱ型呼吸衰竭(RF)的危险因素展开探究。结果 不同组间的住院时间、住院费用、慢性心力衰竭、冠状动脉粥样硬化、进入呼吸科重症监护室率组间差异有统计学意义(P<0.05);高密度脂蛋白胆固醇、载脂蛋白A不同组间差异有统计学意义(P<0.05)。通过二元logistic回归分析发现高血糖(OR=2.576,95%CI:1.128~5.883,P=0.025)、重度及极重度气流受限(OR=5.951,95%CI:2.124~16.668,P=0.010)、低白蛋白水平(OR=3.022,95%CI:1.225~7.456,P=0.016)是COPD病例发生Ⅱ型呼吸衰竭的独立危险因素。结论随MS组分增加,AECOPD患者病情严重程度增加,进入重症监护室的概率更高,合并心血管疾病及并发症增加。MS组分中的高血糖、重度及极重度气流受限、低白蛋白是AECOPD患者出现Ⅱ型呼吸衰竭的独立危险因素。

Objective To analyze the differences between AECOPD patients with different number of MS component,and to explore risk factors of typeⅡrespiratory failure.Methods A retrospectively review the date of 249 cases of AECOPD patients who were treated in our Hospital from January 2014 to December 2017.We divided the patients into 4 groups according to the number of MS components,and analyzed.Results The result was that the difference between the 4 groups was statistically significant in hospitalization days,hospitalization expenses,chronic heart failure,coronary atherosclerosis,RICU rate,HDL-C and Apo A(P<0.05).Binary logistic regression analyze showed that abnormal glucose metabolism(OR=0.946,95%CI:1.128~5.883,P=0.025),severe and very severe airflow limitation(OR=1.783,95%CI:2.124~16.668,P=0.010),low albumin(OR=1.106,95%CI:1.225~7.456,P=0.016)were independent risk factors for typeⅡrespiratory failure in AECOPD cases.Conclusions With the increasing of MS components,AECOPD patients are more likely to enter the ICU,and cardiovascular diseases incidence and complications will increase.Abnormal glucose metabolism,severe and very severe airflow limitation,and low albumin are risk factors for typeⅡrespiratory failure in AECOPD patient.