稳定期慢性阻塞性肺疾病患者十年死亡危险因素分析  

Risk factors for 10-year mortality in patients with stable chronic obstructive pulmonary disease

作　　者：李然[1] 刘晓芳[1] 孙永昌[2] 姚秀娟[1] 陈庆琳 白澎[1] Li Ran;Liu Xiaofang;Sun Yongchang;Yao Xiujuan;Chen Qinglin;Bai Peng(Department of Respiratory and Critical Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Respiratory Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,100730 [2]北京大学第三医院呼吸与危重症医学科,100191

出　　处：《中华全科医师杂志》2021年第11期1134-1140,共7页Chinese Journal of General Practitioners

基　　金：北京市自然科学基金(7212018)。

摘　　要：目的探讨预测稳定期慢性阻塞性肺疾病(慢阻肺)患者10年死亡的独立危险因素。方法收集2010年1—12月北京同仁医院呼吸科诊断稳定期慢阻肺患者的临床资料,并进行10年随访,对影响患者全因及呼吸系统疾病死亡的危险因素进行Cox回归分析。结果共纳入稳定期慢阻肺患者182例,中位随访时间89个月,10年病死率51.1%(93/182),呼吸系统、心血管及脑血管疾病为前3位致死原因。9例患者1年内死亡,173例患者稳定期慢阻肺患者全因病死相关的独立危险因素为高龄(HR=1.936,95%CI:1.610~2.328,P<0.01)、入组时高慢阻肺评估测试评分(CAT评分)(HR=1.331,95%CI:1.049~1.689,P=0.02)及随访1年时CAT评分升高(HR=1.314,95%CI:1.197~1.420,P<0.01),因呼吸系统疾病死亡相关的独立危险因素为入组时高CAT评分(HR=1.719,95%CI:1.026~2.880,P=0.04)、随访1年时CAT评分升高(HR=1.342,95%CI:1.198~1.505,P<0.01)及经肺CT测定的肺气肿指数(LAA%)(HR=1.062,95%CI:1.007~1.120,P=0.03)。结论高龄、入组时高CAT评分、治疗1年后CAT评分升高及LAA%分别是影响稳定期慢阻肺患者全因死亡及因呼吸系统疾病死亡的独立危险因素。Objective To explore the independent risk factors that predict 10-year mortality in patients with stable chronic obstructive pulmonary disease(COPD).Methods The baseline data from a prospective cohort study were analyzed and long-term follow-up were performed.Patients with confirmed diagnosis of stable COPD were consecutively enrolled in the outpatient clinic from January 2010 to December 2010,and were followed up until December 31,2020.Cox regression analysis was used to determine the independent risk factors for all-cause mortality and mortality from respiratory causes in stable COPD patients.Results A total of 182 stable COPD patients were enrolled and followed up for a median of 89 months.The 10-year mortality was 51.1%(93/182),and 9 patients died within one year.The leading cause of death was respiratory disorder,followed by cardiovascular and cerebrovascular diseases.The risk factors independently associated with all-cause mortality included old age(HR=1.936,95%CI:1.610~2.328,P<0.01),increased baseline COPD Assessment Test(CAT)(HR=1.331,95%CI:1.049-1.689,P=0.02)and the increased CAT in one year(HR=1.314,95%CI:1.197-1.420,P<0.01).The risk factors independently associated with respiratory cause mortality included increased baseline CAT(HR=1.719,95%CI:1.026-2.880,P=0.04),emphysema index(LAA%)(HR=1.062,95%CI:1.007-1.120,P=0.03),and one year inecreased CAT(HR=1.342,95%CI:1.198-1.505,P<0.01)was a protective factor.Conclusions Old age,baseline CAT,one year increased in CAT and LAA%were independent influencing factors for 10-year mortality of stable COPD patients.

关 键 词：肺疾病 慢性阻塞性 死亡率 危险因素 

分 类 号：R563.9[医药卫生—呼吸系统]