社区获得性肺炎合并哮喘住院患者临床特征和预后因素分析  

Clinical characteristics and prognostic factors of hospitalized patients with community-acquired pneumonia and asthma

作　　者：陈亮[1] 韩秀迪 朱晓莉[3] 邢西迁[4] CHEN Liang;HAN Xiu-di;ZHU Xiao-li;XING Xi-qian(Department of Infectious Diseases,Beijing Jishuitan Hospital,Fourth Clinical Medical College,Peking University,Beijing 100096,China;Department of Respiratory and Critical Care Medicine,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Occupational Medicine and Toxicology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100043,China;Department of Respiratory and Critical Care Medicine,Yan’an Hospital Affiliated to Kunming Medical University,Kunming 650051,China)

机构地区：[1]北京大学第四临床医学院北京积水潭医院感染疾病科,北京100096 [2]山东省青岛市立医院呼吸与危重症医学科,山东青岛266011 [3]首都医科大学附属北京朝阳医院中毒与职业病医学科,北京100043 [4]昆明医学院附属延安医院呼吸与危重症医学科,云南昆明650051

出　　处：《中国感染控制杂志》2019年第10期902-909,共8页Chinese Journal of Infection Control

基　　金：国家自然科学基金地区科学基金项目(81760015)

摘　　要：目的探讨合并哮喘对社区获得性肺炎(CAP)住院患者疾病特征和预后的影响。方法回顾性收集2013年1月1日—2015年12月31日北京、山东、云南4所医院住院的所有CAP患者病例资料,比较合并哮喘(AS-CAP)和不合并哮喘(非AS-CAP)患者人口学、临床和影像学特征、病原学和临床结局,单因素分析影响AS-CAP住院患者30天病死率的独立危险因素。结果3 901例CAP患者纳入分析,AS-CAP占5.9%(231/3 901)。相比于非AS-CAP患者,AS-CAP患者多为女性,年龄较轻,吸入因素、一年内CAP病史和使用吸入糖皮质激素史多见,发生胸腔积液少见,但PSI分级/CURB-65评分、病原学分布、入住ICU比例和30天病死率以及住院时间两组相似。AS-CAP住院患者30天病死率为2.2%(5/231)。与生存组相比,死亡组男性、脑血管病、慢性肝病、吸入因素和影像学空洞比例更高,PSI分级更高,差异均有统计学意义(均P<0.05)。结论AS-CAP和非AS-CAP患者临床特征和结局相似,合并AS不增加CAP患者病情严重性和30天病死率。除PSI分级外,临床医生还应该重视吸入因素等。Objective To explore the effect of asthma on disease characteristics and prognosis of hospitalized patients with community-acquired pneumonia(CAP).Methods Data of all CAP patients hospitalized in 4 hospitals in Beijing,Shandong and Yunnan from January 1,2013 to December 31,2015 were retrospectively collected,demographic,clinical and imaging characteristics,as well as etiology and clinical outcomes of patients with and without asthma(AS-CAP and non-AS-CAP)were compared,independent risk factors affecting the 30-day mortality of AS-CAP patients were analyzed by univariate analysis.Results 3 901 CAP patients were included in the analysis,AS-CAP accounted for 5.9%(231/3 901).Compared with non-AS-CAP patients,AS-CAP patients were mostly female and younger age,inhalation factors,one-year history of CAP and use of inhaled glucocorticoid were more common,pleural effusion was rare,but pneumonia severity index(PSI)grading/CURB-65 score,etiological distribution,ICU admission ratio,30-day mortality and length of hospital stay were similar between two groups.The 30-day mortality of AS-CAP patients was 2.2%(5/231).Compared with survival group,the proportion of male,cerebrovascular disease,chronic liver disease,inhalation factor and imaging hollow in death group were all higher,and PSI grade was also higher,differences were all statistically significant(all P<0.05).Conclusion Clinical characteristics and outcomes of AS-CAP and non-AS-CAP patients are similar,and combination of AS does not increase the severity and 30-day mortality of CAP patients.In addition to PSI grading,clinicians should also pay attention to inhalation factor.

关 键 词：社区获得性肺炎 哮喘 临床特征 预后因素 

分 类 号：R181.32[医药卫生—流行病学]