福州地区气象因素对慢性阻塞性肺疾病急性加重期住院和呼吸道感染病原菌分布的影响  

Effect of meteorological factors on AECOPD hospitalization and respiratory infection pathogen distribution in Fuzhou

作　　者：薛鸿[1] 汪春辉 许能銮[1] 谢宝松[1] 岳文香[1] 陈愉生[1] 李珍[3] XUE Hong;WANG Chun-hui;XU Neng-luan;XIE Bao-song;YUE Wen-xiang;CHEN Yu-sheng;LI Zhen(Department of Respiratory Medicine and Critical Care Medicine,Fujian Provincial Hospital of Fujian Provincial College of Fujian Medical University,Fuzhou,Fujian350001,China;Meteorological Service Center of Fujian Meteorological Bureau,Fuzhou,Fujian350001,China;Department of Microorganism,Fujian Provincial Hospital of Fujian Provincial College of Fujian Medical University,Fuzhou,Fujian350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院呼吸与危重症医学科,福建省呼吸四病研究室,福建福州350001 [2]福建省气象服务中心,福建福州350001 [3]福建医科大学省立临床医学院福建省立医院微生物室,福建福州350001

出　　处：《临床肺科杂志》2020年第5期658-664,共7页Journal of Clinical Pulmonary Medicine

基　　金：福建省卫生计生委青年科研课题(No.2015-2-4);福建医科大学启航基金(No.2018QH1122);福建省卫生计生委省医学创新课题(No.2017-CX-5)。

摘　　要：目的探究福州市住院慢性阻塞性肺疾病(后简称慢阻肺)急性加重期(AECOPD)患者的临床特点及当地气象要素的关系。方法收集位于福建省立医院2013-2016年期间所有住院的COPD病人临床资料以及同期气温、气压、相对湿度、降水、日照时数以及风速等气象资料。从入院就诊的慢阻肺患者中筛选出具有本地常住户口的病案数据,分析其痰病原学结果并探讨其季节分布特征和影响要素,对各气象要素与因AECOPD患者入院数进行Spearman相关分析以及多元逐步回归分析,建立AECOPD预测模型。结果共纳入816例福州地区AECOPD入院患者资料,结果显示入院人数在3~5月为高峰,11~1月为次高峰,6~9月发病人数相对少。3~6月患者痰培养菌阳性率较高。10~2月发生二氧化碳潴留的患者比率较高。相关性分析显示,AECOPD月发病入院数与平均气温、昼夜温差、平均相对湿度呈相关关系(P<0.05);痰培养菌阳率与平均气温、平均相对湿度、降水量呈相关关系(P<0.05);呼吸衰竭率与平均气压、平均气温、昼夜温差呈相关关系(P<0.05)。AECOPD住院患者痰培养检出病原体共404株,革兰阴性菌占53.22%,真菌为27.72%,革兰阳性菌较少。革兰阴性菌在不同季节的检出率有显著差异,冬季最高(P<0.05),革兰阳性菌及真菌在不同季节的检出率没有明显差异。经多元回归分析后建立AECOPD入院预测方程,回代检验正确率达89.7%。结论结合气象要素分析发现,对AECOPD发病及患者呼吸道病原菌影响较大的气象要素应重点关注日温差、平均相对湿度、平均气压。痰革兰氏阳性菌及真菌检出情况在不同季节没有显著差异,春季及冬季痰革兰氏阴性菌检出率较高,差异有统计学显著性(P<0.05)。Objective To explore the clinical characteristics of inpatients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and their relationship with the meteorological factors of seasonal variation.Methods The clinical data of AECOPD patients with local permanent residence from Fujian Provincial Hospital during the period of 2013-2016 were collected.At the same time,meteorological data including the temperature,the pressure,the relative humidity,the wind velocity and the sunshine were collected.The results of the phlegm etiology was analyzed,and seasonal distribution characteristics and influencing factors were explored.Spearman correlation analysis and multivariate logistics regression analysis were performed to evaluate the relationship of meteorological elements with hospitalization,positive result of sputum culture and the ratio of respiratory failure.The model of AECOPD hospitalization prediction was established and assessed according these data.Results A total of 816 AECOPD inpatients were included.The results showed that the numbers of hospitalization patients were the highest in March to May,followed from November to January.The positive rate of sputum culture was higher in March and June.The ratio of respiratory failure to AECOPD hospitalized patients was higher in October and February.Correlation analysis showed that the numbers of monthly onset of AECOPD hospitalization were correlated with average temperature,diurnal temperature difference and average relative humidity,showing statistical significance(P<0.05).The positive rate of sputum culture was correlated with average temperature,average relative humidity and precipitation,showing statistical significance(P<0.05).Respiratory failure rate was correlated with mean air pressure,mean air temperature and diurnal temperature difference,showing statistical significance(P<0.05).After multiple regression analysis,the prediction equation of admission of AECOPD was established,which showed the correct rate was 89.7%in test.Conclusion It is fou

关 键 词：慢性阻塞性肺疾病急性加重期 住院患者 呼吸道病原体 气象要素 相关分析 

分 类 号：R563.9[医药卫生—呼吸系统]