血红蛋白水平对慢性阻塞性肺疾病患者院内死亡的临床预测价值  

Clinical predictive value of hemoglobin level in mortality of hospitalized COPD patients

作　　者：崔华[1] 魏智民 范利[1] 张梦[1] 刘霖[1] 胡亦新[1] 

机构地区：[1]解放军总医院南楼心血管二科,北京100853 [2]总参警卫局卫生保健处,北京100017

出　　处：《中国应用生理学杂志》2012年第5期394-397,共4页Chinese Journal of Applied Physiology

基　　金：全军医药卫生科研基金课题(06MA290)

摘　　要：目的:在明确贫血对慢性阻塞性肺疾病(COPD)患者产生不良预后的前提下,进一步探讨贫血时的血红蛋白水平对COPD患者器官和功能的影响,以利于对COPD合并贫血的患者进行干预提供临床数据。方法:我们回顾性的研究了北京地区三个三级甲等医院4960例住院COPD患者血红蛋白水平对COPD患者的存活的预测价值。结果:①在4960例COPD患者中,血红蛋白<110 g/L的COPD患者为1009例,1009/4960,占20.34%;②肺栓塞、充血性心力衰竭和慢性肾功能衰竭的患病比例在Hb水平<110 g/L和≥110 g/L的COPD患者组有显著差异(P<0.05),其它临床基线特征无显著性差异(P>0.05);③年龄、吸烟、呼吸衰竭、缺血性心脏病、肺原性心脏病、充血性心力衰竭、房颤、肺栓塞、急性肾功能不全、慢性肾功能不全、PaCO2、PaO2和Hb水平在存活与死亡两组之间均有显著性差异(P<0.01);④逐步筛选变量法多因素非条件Logistic回归结果显示,除肺栓塞、PaCO2和房颤与死亡的相关性无统计学差异外(P>0.05),年龄、吸烟史、Hb水平、PaO2、呼吸衰竭、慢性肾功能衰竭、急性肾功能衰竭、肺源性心脏病、充血性心力衰竭和缺血性心脏病均与死亡密切相关(均P<0.05);⑤血红蛋白水平与死亡密切相关(P<0.01)。结论:低血红蛋白水平(<110 g/L)与死亡密切相关,可以作为预测院内死亡的危险因子之一。Objective： To further investigate an effect of hemoglobin level on organs and functions of chronic obstructive pulmonary diseases（COPD）patients with anemia,in order to provide clinical data on intervention for COPD patients with anemia.Methods： We retrospectively analyzed the predictive value of hemoglobin（Hb） level on the survival of inpatients,collected from 4960 COPD cases of three level of first-class hospitals.Results： ①In 4960 COPD cases,there were 1009 cases with Hb〈110 g/L（males/females was 1009/4960,20.34%）;②The prevalence rate of pulmonary embolism（PE）,congestive heart failure（CHF） and chronic renal failure（CRF） were significantly increased in the Hb level〈110 g/L and ≥110 g/L group（P〈0.05）;③Age,smoking,respiratory failure（RF）,ischemic heart disease（IHD）,pulmonary heart disease（PHD）,CHF,atrial fibrillation（AF）,PE,ARF,CRF,PaCO2,PaO2,and Hb levels were significantly different between survival and death group（P〈0.01）;④ Using stepwise regression analysis,age,smoking,Hb level,PaO2,RF,CRF,ACF,PHD,CHF and IHD had significantly association with death（P〈0.05）;⑤ Hb levels was significantly associated with death（95% CI 1.2975-2.8512,P = 0.0014）.Conclusion： Low hemoglobin level（〈 110 g/L） was significantly associated with death,and thus may be a valuable predictive marker for mortality of hospitalized COPD patients.

关 键 词：血红蛋白水平 COPD 预测 死亡 

分 类 号：R54[医药卫生—心血管疾病]