影响慢性阻塞性肺疾病急性加重期糖皮质激素剂量选择的危险因素分析  

Risk Factors Affecting the Dose Selection of Glucocorticoids in the Treatment of AECOPD

作　　者：王洪群[1] 王兴胜[1] 王虎成[1] 陈曦[1] Wang Hongqun;Wang Xingsheng;Wang Hucheng;Chen Xi(Department of Respiratory Disease,Chongqing Emergency Medical Center/Chongqing the Fourth People＇s Hospital/CentralHospitalAf-filiated to Chongqing University,Chongqing,400014,P.R.China)

机构地区：[1]重庆市急救医疗中心/重庆市第四人民医院/重庆大学附属中心医院呼吸内科,重庆400014

出　　处：《老年医学与保健》2018年第3期247-250,共4页Geriatrics & Health Care

基　　金：重庆市卫生计生委医学科研计划项目(20142081)

摘　　要：目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)治疗选择糖皮质激素剂量的影响因素。方法回顾性分析2014年7月—2016年12月收住院157例AECOPD患者的资料。将患者按糖皮质激素(泼尼松等效剂量)日均剂量>1 mg/kg/d作为高剂量组,日均剂量≤1 mg/kg/d作为非高剂量组,对比分析影响激素剂量选择的危险因素;并对有多风险因素的AECOPD患者分别接受高剂量和非高剂量激素治疗的预后和不良反应进行比较和统计学分析。结果高剂量组中频繁急性加重史、高剂量激素使用史、m MRC评分高、肺功能损害重和CO_2潴留重等因素与低剂量组有明显差异(<0.05);多因素Logistic回归分析显示频繁急性加重史(OR=4.214)、高剂量激素使用史(OR=2.836)、m MRC评分高(OR=3.357)为高剂量全身激素使用的独立影响因素(P<0.05);对多危险因素AECOPD患者进行亚组分析,使用高剂量激素较低剂量激素者治疗失败率更低(23.68%48.39%,P<0.05)。结论当AECOPD患者既往有频繁急性加重史、高剂量激素使用史和m MRC评分高等危险因素时,初始高剂量糖皮质激素治疗可能获益更多。Objective To explore the influencing factors on the dose selection of glucocorticoids in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods A retrospective analysis was made to the clinical data of 157 cases with AECOPD hospitalized during the period from July, 2017 to Dec., 2017; based on the average dose of daily glucocorticoid（equivalent to prednison）, the cases were divided into 2 groups： high-dose group（P1 mg/kg/d） and non-highdose group（1 mg/kg/d）; the risk factors affecting dose selection were comparatively studied; the prognosis and adverse effects in the cases with multi-risk factors in the 2 groups were compared and statistically analyzed. Results There existed a statistical difference in history of frequent exacerbation, history of high-dose glucocorticoid use, high m MRC scores, severe lung function damage and CO_2 retention between the 2 groups（ P0.05）; multiple logistic regression analysis showed that history of frequent exacerbation（OR=4.214）, history of high-dose glucocorticoid use（OR=2.836） and high m MRC scores（OR=3.357） were the independent infleuncing factors in the systematic glucocorticoid use（P 0.05）; in cases with multi-risk factors, the treatment failure rate was lower in high-dose group（23.68%） than that in non-high-dose group（48.39%）（P 0.05）. Conclusions Treatment with initiao high dose of glucocorticoids is of bigger benefit for AECOPD cases with any one of the following 3 risk factors： history of frequent exacerbation, history of high-dose glucocorticoid use and high m MRC score.

关 键 词：慢性阻塞性肺疾病 急性加重期 糖皮质激素 治疗 

分 类 号：R563.9[医药卫生—呼吸系统]