老年哮喘-慢性阻塞性肺疾病重叠综合征急性加重期临床预后的影响因素分析  

Analysis of clinical prognostic factors in acute exacerbation of asthma-chronic obstructive pulmonary disease overlap syndrome in the elderly patients

作　　者：杨雅婷 刘菁菁 张洁[1] 马丽 张海燕[2] 赵建清[1] Yang Yating;Liu Jingjing;Zhang Jie;Ma Li;Zhang Haiyan;Zhao Jianqing(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075000,China;Department of Outpatient,the First Affiliated Hospital of Hebei North University,Hebei,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院呼吸与危重症医学科,河北张家口075000 [2]河北北方学院附属第一医院门诊部,河北张家口075000

出　　处：《中国医学前沿杂志（电子版）》2020年第4期25-29,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：河北省医学科学研究重点课题(20160366)。

摘　　要：目的探讨老年哮喘-慢性阻塞性肺疾病重叠综合征(asthma-chronic obstructive pulmonary disease overlap syndrome,ACOS)急性加重期患者临床预后的影响因素。方法回顾性分析2015年1月至2019年2月河北北方学院附属第一医院收治的138例老年ACOS急性加重期患者的临床资料,根据发病后3个月患者预后将其分为死亡组和存活组。比较两组患者的基线资料、临床资料和实验室检查结果。采用多因素Logistic回归分析探讨影响老年ACOS急性加重期患者发病后3个月死亡的独立因素。结果138例患者入院后3个月内共有16例患者因ACOS死亡,病死率为11.6%,归为死亡组,其余122例患者归为存活组。死亡组患者的年龄、呼吸衰竭发生率、多重耐药菌感染发生率、入院时急性生理学和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血白细胞计数、嗜酸性粒细胞百分比、C反应蛋白、乳酸、D-二聚体、氨基末端B型利钠肽前体水平均显著高于存活组(均P<0.05),体质指数、白蛋白水平均显著低于存活组(均P<0.05)。多因素Logistic回归分析结果显示,多重耐药菌感染、入院时APACHEⅡ评分、乳酸和D-二聚体水平均为老年ACOS急性加重期患者死亡的独立危险因素(均P<0.05)。结论老年ACOS急性加重期患者的临床预后较差,多重耐药菌感染、入院时APACHEⅡ评分、乳酸和D-二聚体水平均是导致患者发病后3个月死亡的独立危险因素。Objective To investigate the clinical prognostic factors in acute exacerbation of asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS)in the elderly patients.Method The clinical data of 138 elderly ACOS patients with acute exacerbation admitted to the First Affiliated Hospital of Hebei North University from January 2015 to February 2019 were analyzed retrospectively,and they were divided into death group and survival group according to the prognosis of 3 months after the onset.The baseline data,clinical data and laboratory test results of all patients were compared between the two groups.Multivariate Logistic regression analysis was used to explore the independent related factors for the death during 3 months after the onset of disease.Result A total of 16 patients died of ACOS within 3 months after admission,and they were classified as death group,whose mortality rate was 11.6%.The other 122 patients were classified as survival group.The age,incidence of respiratory failure,incidence of multiple drug resistant bacteria infection,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,white blood cell count,percentage of eosinophils,C reactive protein,lactic acid,D-dimer,N-terminal pro-B type natriuretic peptide levels at admission in death group were significantly higher than those in survival group(all P<0.05),and the body mass index and albumin level were significantly lower than those of survival group(all P<0.05).Multivariate Logistic regression analysis showed that multiple drug resistant bacteria infection,APACHEⅡscore,lactic acid,and D-dimer levels at admission were the independent risk factors for death in elderly patients with acute exacerbation of ACOS(all P<0.05).Conclusion The clinical prognosis of elderly patients with acute exacerbation of ACOS is poor.Multiple drug resistant bacterial infection,admission APACHEⅡscore,lactic acid and D-dimer levels are independent risk factors for death of 3 months after onset.

关 键 词：哮喘-慢性阻塞性肺疾病重叠综合征 急性加重期 预后 危险因素 老年 

分 类 号：R563.9[医药卫生—呼吸系统] R562.25[医药卫生—内科学]