上海地区三甲医院频繁与非频繁急性加重稳定期COPD患者的临床特征差异及其临床意义  

Clinical characteristics and significance of COPD patients with frequent and non-frequent exacerbations in stable stage in Third class and Grade-A hospitals of Shanghai area

作　　者：冯秀敏 葛海燕[2] 戈霞晖 张景熙 白冲 朱惠莉[2] Feng Xiumin;Ge Haiyan;Ge Xiahui;Zhang Jingxi;Bai Chong;Zhu Huili(Department of Respiratory and Critical Care Medicine,Changhai Hospital Affiliated to Navy Military Medical University,Shanghai 200433,China;Department of Respiratory and Critical Care Medicine,Huadong Hospital,Fudan University,Shanghai 200040,China;Department of Respiratory and Critical Care Medicine,the 7th People's Hospital of Shanghai,Shanghai 200000,China)

机构地区：[1]海军军医大学附属长海医院呼吸与危重症医学科,上海200433 [2]复旦大学附属华东医院呼吸与危重症医学科,上海200040 [3]上海市第七人民医院呼吸与危重症医学科,200000

出　　处：《国际呼吸杂志》2020年第5期327-335,共9页International Journal of Respiration

基　　金：国家自然科学基金(81670016)。

摘　　要：目的调查并比较上海地区部分三级甲等医院就诊的频繁急性加重组(FE)及非频繁急性加重(NFE)组稳定期COPD患者临床特征差异并分析其临床意义。方法采用多中心、横断面调查方法回顾性分析总结2018年10月至2019年6月在门诊就诊的113例稳定期COPD患者临床症状评分、肺功能水平、血清学指标及合并症分布特征,将患者分为FE组(n=60)和NFE组(n=53),比较2组间上述结果的差异。结果(1)一般特征:患者年龄为(67.84±8.66)岁,2组患者年龄、病程、吸烟指数差异无统计学意义,FE组BMI低于NFE组[(22.49±3.32)kg/m2比(24.07±3.58)kg/m2,t=2.431,P=0.017],FE组CAT评分[(17.30±7.59)分比(11.38±6.38)分,t=-4.458,P<0.001]、SGRQ评分[(37.29±14.82)分比(23.18±12.57)分,t=-5.288,P<0.001]、BODE指数[(3.96±1.97)分比(3.05±2.25)分,t=-2.061,P<0.042]、HAMA评分[14(12)分比9(8)分,Z=-2.183,P=0.029]及GOLD3-4级患病率(63.6%比43.1%,χ^2=4.473,P=0.034)均高于NFE组,差异有统计学意义。(2)肺功能:FE组吸入支气管扩张剂前FEV1、FEV1%pred、FVC%pred、FEF25-75、FEF25-75%pred、FEF50、FEF50%pred、DLCO%pred低于NFE组[分别为(1.14±0.47)L比(1.39±0.64)L,t=2.314,P=0.023;(43.82±16.50)%比(53.13±20.88)%,t=2.534,P=0.013;(69.06±17.85)%比(76.65±19.14)%,t=2.110,P=0.037;(0.49±0.29)L比(0.66±0.40)L,t=2.569,P=0.012;(16.50±8.69)%比(21.81±12.58)%,t=2.723,P=0.008;(0.60±0.41)L比(0.84±0.58)L,t=2.374,P=0.020;(15.97±9.72)%比(22.14±13.91)%,t=2.652,P=0.009;(54.35±21.90)%比(65.20±25.67)%,t=2.133,P=0.036],吸入支气管扩张剂后FEV1/FVC%、FEV1、FEV1%pred、FEF25-75、FEF50%pred均显著低于NFE组[分别为(49.38±12.16)%比(55.57±11.71)%,t=2.508,P=0.014;(1.32±0.52)L比(1.57±0.65)L,t=2.059,P=0.042;(50.12±17.18)%比(60.22±20.57)%,t=2.591,P=0.011;(0.59±0.37)L比(0.75±0.42)L,t=2.026,P=0.046;(19.99±12.12)%比(26.23±14.81)%,t=2.242,P=0.027],差异均有统计学意义。(3)血清学指标:FE组血红蛋白浓度显著低于NFE组[142(21)g/L比148(18)g/L,Z=-2.159,PObjective To investigate and compare the clinical characteristics of stable chronic obstructive pulmonary disease(COPD)patients in the frequent exacerbation(FE)and non frequent exacerbation(NFE)groups from the several Third class and Grade-A hospitals of Shanghai area,and analyze their clinical significance.Methods The clinical symptoms score,pulmonary lung function results,serum markers and the distribution of comorbidities of 113 patients diagnosed of stable COPD from October 2018 to June 2019 were analyzed and summarized in a retrospective,multicenter and cross-sectional survey.The patients were divided into FE group(n=60)and NFE group(n=53)and compared the differences between the two groups.Results(1)General characteristics:The mean age was(67.84±8.66)years old.There was no significant difference in age,course of disease and smoking exposure between the two groups.BMI in FE group was lower than that of in NFE group[(22.49±3.32)kg/m2 vs(24.07±3.58)kg/m2,t=2.431,P=0.017].The CAT score[(17.30±7.59)vs(11.38±6.38),t=-4.458,P<0.001],SGRQ score[(37.29±14.82)vs(23.18±12.57),t=-5.288,P<0.001],BODE index[(3.96±1.97)vs(3.05±2.25),t=-2.061,P<0.042],HAMA score[14(12)vs 9(8),Z=-2.183,P=0.029],and the morbidity of GOLD3-4 patients(63.6%vs 43.1%,χ^2=4.473,P=0.034)in FE group were all higher than those of in NFE group,there were significant differences in those results.(2)Pulmonary function:The results of FEV1,FEV1%pred,FVC%pred,FEF25-75,FEF25-75%pred,FEF50,FEF50%pred,DLCO%pred before bronchodilator inhalation in FE group were lower than those of NFE group[(1.14±0.47)L vs(1.39±0.64)L,t=2.314,P=0.023;(43.82±16.50)%vs(53.13±20.88)%,t=2.534,P=0.013;(69.06±17.85)%vs(76.65±19.14)%,t=2.110,P=0.037;(0.49±0.29)L vs(0.66±0.40)L,t=2.569,P=0.012;(16.50±8.69)%vs(21.81±12.58)%,t=2.723,P=0.008;(0.60±0.41)L vs(0.84±0.58)L,t=2.374,P=0.020;(15.97±9.72)%vs(22.14±13.91)%,t=2.652,P=0.009;and(54.35±21.90)%vs(65.20±25.67)%,t=2.133,P=0.036 respectivly].The results of FEV1/FVC,FEV1,FEV1%pred,FEF25-75,FEF50%pred after bronch

关 键 词：肺疾病 慢性阻塞性 急性加重 肺功能 过敏体质 合并症 

分 类 号：R563[医药卫生—呼吸系统]