慢性阻塞性肺疾病稳定期患者共患疾病与死亡风险的关系研究  

Research of association between comorbidity and mortality in patients with stable chronic obstructive pulmonary disease

作　　者：李然[1] 刘晓芳[1] 王玉红[1] 白澎[1] Li Ran;Liu Xiaofang;Wang Yuhong;Bai Peng(Department of Respiratory and Critical Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属同仁医院呼吸与危重医学科,北京100730

出　　处：《临床内科杂志》2022年第4期241-245,共5页Journal of Clinical Internal Medicine

基　　金：北京市自然科学基金资助项目(7212018)

摘　　要：目的探讨慢性阻塞性肺疾病(简称慢阻肺)共患疾病与死亡风险的关系。方法纳入慢阻肺稳定期患者166例,收集其临床资料,统计共患疾病数量、种类及英国医学研究委员会呼吸困难量表(mMRC)、慢性阻塞性肺疾病评估测试(CAT)、Charlson合并症指数(CCI)及年龄校正的CCI(ACCI)评分,对入组患者进行3年随访。根据ACCI评分中位数将患者分为高分组(97例)和低分组(69例);根据共患疾病数量中位数将患者分为较多共患疾病组(78例)和较少共患疾病组(88例);根据3年随访结果将患者分为存活组(127例)和死亡组(39例),比较各组患者临床资料。采用Cox风险比例模型分析慢阻肺稳定期患者预后的独立危险因素。结果高分组年龄、吸烟指数、CAT评分、过去1年慢阻肺急性加重次数、共患疾病数量、死亡患者比例均高于低分组,而第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)和FEV_(1)占预计值的百分比(FEV_(1)%pred)均低于低分组(P<0.05)。较多共患疾病组年龄、CCI评分、吸烟指数、CAT评分、过去1年慢阻肺急性加重次数、ACCI评分及死亡患者比例均高于较少共患疾病组,而FEV_(1)/FVC和FEV_(1)%pred均低于较少共患疾病组(P<0.05)。死亡组年龄、CAT评分、过去1年慢阻肺急性加重次数、CCI评分、ACCI评分、共患疾病数量及合并缺血性心脏病、心力衰竭及骨质疏松患者比例均高于存活组(P<0.05)。Cox风险比例模型回归分析结果显示,过去1年慢阻肺急性加重次数(HR=1.959,95%CI 1.452~2.642,P<0.001)和ACCI评分(HR=1.950,95%CI 1.346~2.824,P<0.001)均为慢阻肺稳定期患者3年随访期间死亡的独立危险因素。结论共患疾病与慢阻肺稳定期患者病情严重程度及长期病死率密切相关。Objective To explore the association between comorbidity and mortality in patients with stable chronic obstructive pulmonary diseas(COPD).Methods A total of 166 patients with stable COPD were enrolled.Clinical data were collected,number and type of comorbidities,British Medical Research Council Dyspnea Scale(mMRC),COPD assessment test(CAT),Charlson comorbidity index(CCI),age-adjusted CCI(ACCI)score were calculated,and 3-year follow-up were performed.According to the median ACCI score,patients were divided into high score group(97 cases)and low score group(69 cases).According to the median number of comorbidities,patients were divided into more comorbidities group(78 cases)and less comorbidities group(88 cases).According to the result of 3-year follow-up,patients were divided into alive group(127 cases)and dead group(39 cases).The clinical date of each group were compared.Independent risk factors for mortality of patients with stable COPD was analyzed by Cox proportional hazards model.Results Age,smoking index,CAT score,number of acute exacerbations of COPD in last year,number of comorbidities,proportion of patients who died in high score ACCI group were higher than those in low score group,while forced expiratory volume in 1 second(FEV_(1))/forced vital capacity(FVC)and percentage of FEV_(1)to predicted(FEV_(1)%pred)were lower than those in low score group(P<0.05).Age,CCI score,smoking index,CAT score,number of acute exacerbations of COPD in last year,ACCI score and proportion of patients who died in more comorbidities group were higher than those in less comorbidities group,while FEV_(1)/FVC and FEV_(1)%pred were lower than those in less comorbidities group(P<0.05).Age,CAT score,number of acute exacerbations of COPD in last year,CCI score,ACCI score,number of comorbidities,patients with ischemic heart disease,heart failure and osteoporosis in dead group were higher than those in alive group(P<0.05).Cox proportional hazards model analysis showed that the frequency due to acute exacerbation in last year(HR=1.959,9

关 键 词：肺疾病 慢性阻塞性 并发症 病死率 

分 类 号：R563.9[医药卫生—呼吸系统]