慢性阻塞性肺疾病急性加重预测因子的初步研究  

Predicting risk factors for exacerbation in patients with chronic obstructive pulmonary disease

作　　者：张悦[1] 郭雪君[1] 孙晋渊[1] 杨天芸[1] 王妍敏[1] Zhang Yue;Guo Xuejun;Sun Jinyuan;Yang Tianyun;Wang Yanmin(Department of Respiratory Medicine,Shanghai Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院呼吸内科,200092

出　　处：《国际呼吸杂志》2020年第20期1531-1536,共6页International Journal of Respiration

基　　金：上海市科委基金(17511108502)。

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)急性加重的预测因子,并开发一种预测量表,使临床医师能够对COPD患者进行筛查,尽早发现COPD急性加重的患者。方法收集2017年7月至2019年6月来上海交通大学医学院附属新华医院呼吸内科就诊的COPD患者323例,其中COPD稳定期患者129例,急性加重期患者194例。在患者到达门诊或急诊时由临床医师评估和收集可能的预测变量的信息,建立多元回归模型,确定与COPD急性加重有关的因素。结果COPD急性加重的预测因子包括患者年龄、需要长期家庭氧疗或无创机械通气治疗,就诊时的心率,血清白细胞介素6(IL-6)、白细胞介素2受体(IL-2R)、C反应蛋白(CRP)、血清尿素氮(BUN)和血浆白蛋白水平。如COPD急性加重风险评分高于5分,则患者出现急性加重的可能性大。结论在临床变量的基础上增加血IL-6、IL-2R、CRP、白蛋白、BUN水平能显著改善临床变量的预测能力,以期早期发现COPD急性加重的患者,指导临床筛查高危病例。Objective To explore the predictive factors of chronic obstructive pulmonary disease(COPD)acute exacerbations and develop a predictive scale that allows clinicians to stratify patients with COPD and identify patients with COPD acute exacerbations(AECOPD).Methods A total of 323 patients with COPD from Shanghai Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were recruited between July 2017 to June 2019,including 129 cases with stable period and 194 cases with AECOPD.Information about possible predictors was assessed and immediately collected by the clinicians upon patient arrival at the outpatient clinic or emergency department.A multiple regression model was applied to identify factors related to COPD exacerbations.Results Predictors for COPD acute exacerbation were patient′s age,previous need for long-term home oxygen therapy or non-invasive mechanical ventilation,heart rate,systemic levels of interleukin(IL-6),Interleukin-2 receptor(IL-2R),C-reactive protein(CRP),Serum urea nitrogen(BUN)and plasma albumin.When the AECOPD risk score was higher than 5,the probability of exacerbation was high.Conclusions On the basis of clinical variables,serum IL-6,IL-2R,CRP,albumin and BUN levels can significantly improve the predictive ability of clinical variables,so as to find patients with COPD acute exacerbation and guide clinical screening of high-risk cases.

关 键 词：肺疾病 慢性阻塞性 生物标志物 预测因子 急性加重 

分 类 号：R563.9[医药卫生—呼吸系统]