慢性阻塞性肺疾病频繁急性加重的影响因素

Factors influencing frequent acute exacerbations of chronic obstructive pulmonary disease

目的:慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病情频繁急性加重严重影响患者生命质量、加速病情进展和增加社会经济负担,但目前国内外关于如何尽早识别此型COPD患者的研究较少。本研究比较COPD患者频繁急性加重表型和非频繁急性加重表型的临床差异,以便更早识别和管理频繁急性加重表型患者。方法:回顾性收集2022年10月至2023年7月于武汉市第三医院呼吸与危重症医学科住院治疗的82例COPD患者的临床资料,根据其既往1年急性加重次数分为非频繁急性加重组和频繁急性加重组,比较2组患者一般资料、合并症、肺功能指标、治疗情况、常规血液检验指标、血气分析指标的差异。结果:频繁急性加重组急性加重次数、COPD病程、住院天数、住院费用、联合使用抗生素的人数、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)均高于非频繁急性加重组,第1秒用力呼气容积/用力肺活量(forced expiratory volume in the first second/forsed vital capacity,FEV_(1)/FVC)、第1秒用力呼气容积占预计值百分比(forced expiratory volume in the first second of predicted value,FEV_(1)%pred)均小于非频繁急性加重组,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示:吸烟史、COPD病程为COPD频繁急性加重的独立影响因素(P<0.05)。受试者操作特征(receiver operator characteristic,ROC)曲线分析结果显示:COPD病程、NLR、PLR的曲线下面积均大于0.5,差异均有统计学意义(均P<0.05)。结论:COPD病程、NLR及PLR可能是COPD频繁急性加重的危险因素。

Objective:Frequent acute exacerbations of chronic obstructive pulmonary disease(COPD)significantly impact patients’quality of life,accelerate disease progression,and increase socio-economic burdens.However,there are currently few studies,both domestically and internationally,on how to identify these COPD patients early.This study compares the clinical differences between COPD patients with frequent acute exacerbations and those without to facilitate earlier identification and management of the former.Methods:A retrospective study was conducted on 82 COPD patients hospitalized in the Department of Respiratory and Critical Care Medicine,Wuhan Third Hospital from October 2022 and July 2023.Based on the number of acute exacerbations in the previous year,patients were divided into 2 groups:a non-frequent exacerbation group and a frequent exacerbation group.The differences in general data,comorbidities,lung function indicators,treatment conditions,routine blood test indicators,and blood gas analysis indicators were compared between the 2 groups.Results:The frequent exacerbation group had higher numbers of acute exacerbations,longer COPD duration,longer hospital stays,higher hospitalization costs,more combined antibiotic use,higher neutrophil/lymphocyte ratio(NLR),and higher platelet/lymphocyte ratio(PLR)than the non-frequent exacerbation group.The forced expiratory volume in the first second/forced vital capacity(FEV_(1)/FVC)and the percentage of predicted forced expiratory volume in the first second(FEV_(1)%pred)were lower in the frequent exacerbation group,with statistically significant differences(all P<0.05).Logistic regression analysis showed that smoking history and COPD duration were independent influencing factors for frequent acute exacerbations of COPD(both P<0.05).Receiver operator characteristic(ROC)curve analysis showed that the area under the curve for COPD duration,NLR,and PLR was greater than 0.5,with statistically significant differences(all P<0.05).Conclusion:COPD duration,NLR,and PLR may be risk factors for frequent acute exacerbations of COPD.