老年中度慢性阻塞性肺疾病长期预后随访研究  

Long-term follow-up study of moderate chronic obstructive pulmonary disease in elderly patients

作　　者：向平超[1] 姚震[1] 程显声[2] 张二明[1] 张鑫[1] 宋丽萍[1] 鞠立新[1] 丁彦[1] 张莹[1] 

机构地区：[1]北京大学首钢医院呼吸科,100041 [2]中国医学科学院中国协和医科大学阜外心血管病医院肺血管病研究室

出　　处：《中华结核和呼吸杂志》2006年第9期583-586,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家"九五"科技攻关课题基金(96-906-02-03)

摘　　要：目的探讨老年中度慢性阻塞性肺疾病(COPD)患者的预后及其长期生存的影响因素,指导临床评估 COPD 的病情和预后。方法采用前瞻性固定队列研究方法,于1993年5月对北京石景山区首钢医院管理的居民区内191例老年中度 COPD 患者进行基线调查,记录患者的一般情况,并进行动脉血气分析、肺功能、心电图、X 线胸片及6分钟行走试验(6MWT)等检查,对生存状况和死亡原因进行长达12年的随访。采用 Kaplan-Meier 法进行存活率的单因素分析;显著性检验采用Log-rank 方法;对所选的基线因素行 COX 比例风险模型单变量和多变量分析。结果 12年因原址迁移失访10例,26例死于非 COPD 疾病、52例死于 COPD 疾病。5年存活率为81.7%(156/191),12年存活率为56.9%(103/181)。COX 多变量分析结果显示,与老年中度 COPD 患者预后有关因素有体重指数[BMI,相对危险度(RR)=0.916,95%可信区间(95%CI)为0.841～0.996]、第一秒用力呼气容积(FEV_1,RR=0.999,95%CI 为0.998～1.000)、动脉血氧分压(PaO_2,RR=0.929,95%CI 为0.892～0.967)、6MWT(RR=0.997,95%CI 为0.995～1.000)、肺性 P 波(RR=4.081,95%CI 为1.567～10.624)。结论基线 BMI、FEV_1、PaO_2、6MWT、肺性 P 波是预测老年中度 COPD 患者生存及预后的重要因素。Objective To investigate the prognosis of moderate chronic obstructive pulmonary disease（COPD） in the elderly patients,and to evaluate the factors for long term survival. Methods From May 1993 ,a pmspactive cohort study was carried out,in which 191 elderly patients with moderate COPD were recruited in Shougang communities, Shijingshan District, Beijing. The general health state, arterial blood gas, pulmonary function test, electrocardiograph, chest X-ray and 6-minute-walk test（6MWT） were recorded. The patients were followed for 12 years. Univariate analysis of survival rate was performed by Kaplan-Meier method. The significance test was done by Log-rank method, and the baseline factors were analyzed using the COX regression model multiplicity. Results During the 12 years of follow-up,10 patients were lost because of migration. Twenty-six patients died of non-COPD diseases,while 52 died of COPD. The survival rate was 81.7% （ 156/191 ） in 5 years,and 56. 9% （ 103/181 ） in 12 years. The result with COX multiplicity showed that the important factors for prognosis of the patients were body mass index [ BMI, relative risk （ RR ） = 0. 916,95% confidence intervals（95% CI） =0. 841 -0. 996] ,forced expired volume in one second（ FEV1, RR = 0. 999,95% CI = 0. 998 - 1. 000 ）, arterial partial pressure of oxygen （ PaO2, RR = 0. 929,95% CI = 0. 892 - 0. 967 ） ,6MWT（ RR = 0. 997,95% CI = 0. 995 - 1. 000 ） and P pulmonale of ECG （ RR = 4. 081, 95% CI = 1. 567 - 10. 624）. Conclusion The important factors for prognosis of moderate COPD in elderly patients included BMI,FEV1 ,PaO2 ,6MWT and P Dulmonale in ECG.

关 键 词：肺疾病 慢性阻塞性 预后 队列研究 因素分析 统计学 

分 类 号：R563.9[医药卫生—呼吸系统]