上海市嘉定镇40岁及以上居民慢性阻塞性肺疾病筛查结果及其关联因素分析

Analysis on screening results for chronic obstructive pulmonary disease among residents over 40 years in Shanghai Jiading town

目的开展上海市嘉定镇40岁及以上人群慢性阻塞性肺疾病(慢阻肺)筛查,探讨嘉定镇居民慢阻肺患病情况及其关联因素。方法该研究为横断面研究。2023年7月10—18日,采用多阶段分层随机抽样的方法抽取嘉定镇400名40岁及以上的居民作为调查对象。采用移动终端作为调查工具,完成慢阻肺筛查问卷调查,问卷内容包括个人基本信息、疾病既往史和家族史、疾病行为和危险因素,并对所有纳入筛查项目的居民进行体格检查及肺功能检测。第1秒用力呼气容积/用力肺活量(FEV 1/FVC)<70%且排除其他心肺疾病者诊断为慢阻肺患者,定义为慢阻肺组,其余居民定义为非慢阻肺组。采用logistic回归分析慢阻肺患者与非慢阻肺居民在性别、烟草接触、慢阻肺家族史、哮喘史等方面的差异,并分析关联因素。结果400名居民中,男性166名(41.5%),女性234名(58.5%)。筛查出高危者181名(45.3%);确诊慢阻肺患者32名,患病率8.0%;其中男性22例,患病率13.3%,女性10例,患病率4.3%。慢阻肺组与非慢阻肺组除了性别差异有统计学意义外(P<0.05),年龄(P=0.993)、文化程度(P=0.158)、体重指数(P=0.776)、腰臀比(P=0.833)等比较差异均无统计学意义。Logistic回归分析显示,14岁及以前经常咳嗽(OR=7.763,95%CI:2.898~20.791,P<0.05),17岁及以前因患肺炎或支气管炎住院(OR=4.359,95%CI:1.343~14.1462,P<0.05),罹患哮喘(OR=11.800,95%CI:2.001~69.573,P<0.05)、慢性支气管炎(OR=72.748,95%CI:20.501~258.144,P<0.05)、肺气肿(OR=23.600,95%CI:1.407~395.756,P<0.05)等呼吸道疾病,直系亲属有慢性支气管炎(OR=6.112,95%CI:1.960~19.058,P<0.05)及慢阻肺家族史(OR=100.920,95%CI:14.625~696.390,P<0.05),有吸烟行为(OR=7.017,95%CI:2.605~18.906,P<0.05),14岁及以前与每天吸烟者共同生活(OR=35.481,95%CI:1.609~782.310,P<0.05),接触二手烟(OR=3.448,95%CI:1.271~9.352,P<0.05)等与嘉定镇40岁以上社区人群患慢阻肺呈正向关联。结论上海市嘉定镇40岁以上人群慢阻肺患病率男性高于女性。筛查时应重点关注14岁及以前经常咳嗽、17岁及以前因患肺炎或支气管炎而住院、罹患呼吸道疾病、直系亲属有慢性阻塞性肺疾病等家族史、有吸烟史、14岁及以前与每天吸烟者共同生活或被动吸烟等。

Objective To analyze the screening results for chronic obstructive pulmonary disease(COPD)among residents aged 40 years and above in Shanghai Jiading Town,and to explore the influencing factors of COPD.Methods The study was a cross-sectional study.Four hundred residents aged 40 years and above in Jiading Town were selected to attend COPD screening by multi-stage stratified random sampling method from 10 to 18 July,2023.Information on demographic characteristics,disease history and family history,disease behavior and risk factors were collected by a questionnaire survey.Physical examination and pulmonary function tests were performed for all participants.Patients showing<70%FEV 1/FVC in pulmonary function and excluded of other cardiorespiratory diseases were diagnosed as the COPD.The SPSS 25.0 software was used for statistical analysis;and logistic regression was used to analyze the related factors of COPD.Results There were 166(41.5%)males and 234(58.5%)females in the participants.The results of screening showed that 181(45.3%)individuals were identified as high risk of COPD and 32 cases of COPD was diagnosed with a prevalence rate of 8.0%.The prevalence rate of COPD in males were significantly higher than that in females(P<0.05).There were no significant differences in the age(P=0.993),education level(P=0.158),body mass index(P=0.776),and waist-to-hip ratio(P=0.833)between COPD patients and non-COPD participants.Logistic regression analysis showed that frequent coughing at 14 years of age and before(OR=7.763,95%CI:2.898-20.791,P<0.05),Hospitalization for pneumonia or bronchitis at or before 17 years of age(OR=4.359,95%CI:1.343-14.1462,P<0.05),asthma(OR=11.800,95%CI:2.001-69.573,P<0.05),chronic bronchitis(OR=72.748,95%CI:20.501-258.144,P<0.05),emphysema(OR=23.600,95%CI:1.407-395.756,P<0.05),and other respiratory diseases,immediate family members with chronic bronchitis(OR=6.112,95%CI:1.960-19.058,P<0.05)and family history of COPD(OR=100.920,95%CI:14.625-696.390,P<0.05),smoking behavior(OR=7.017,95%CI:2.605-18.906,P<0.05),living with daily smokers(OR=35.481,95%CI:1.609-782.310,P<0.05),and second-hand smoking(OR=3.448,95%CI:1.271-9.352,P<0.05)were independent risk factors for the development of COPD.Conclusion The study shows the prevalence of COPD and related risk factors in residents over the age of 40 in Shanghai Jiading town,indicating that more attention should be paid for high risk population in COPD screening.