北京市某三甲医院慢性阻塞性肺疾病住院患者变化趋势及影响因素分析  

Trend and Influential Factors of Hospitalized Patients with Chronic Obstructive Pulmonary Disease in A Level A Tertiary Hospital in BeiJing

作　　者：原源[1] 田巍[1] 邓晓慧[1] 岳睿[1] 葛晓竹 Yuan Yuan;Tian Wei;Deng Xiaohui;Yue Rui;Ge Xiaozhu(Department of Geriatrics,Beijing Jishuitan Hospital,Beijing 100035)

机构地区：[1]北京积水潭医院老年医学科,北京100035

出　　处：《国际老年医学杂志》2022年第4期420-424,共5页International Journal of Geriatrics

基　　金：北京市属医院科研培育项目(PZ2021004)。

摘　　要：目的随着北京市空气质量的改善以及新冠疫情对呼吸道慢病管理与个人卫生习惯的影响,有必要对近年来医院慢性阻塞性肺疾病(COPD)入院患者的变化趋势及预后影响因素进行回顾性分析,为临床工作提供数据参考。方法登录北京市生态环境监测中心官网,收集北京市2015~2020年度细颗粒物(PM_(2.5))、可吸入颗粒物(PM_(10.0))、二氧化硫(SO_(2))、二氧化氮(NO_(2))以及累计优良天数的公共数据信息;调取2015年1月~2020年12月北京积水潭医院诊断为COPD伴或不伴急性加重/肺部感染的所有病例(共1493例),进行回顾性研究。结果COPD入院人数以12月至次年2月最多,之后逐步下降,7月达谷值;就年度变化趋势而言,从2017年开始COPD入院人数出现下降,2020年出现显著下降。相关性分析显示入院人数与空气质量指标PM_(2.5)、PM_(10.0)、SO_(2)、NO_(2)水平以及累计优良天数均呈显著相关(P<0.05),COPD入院病死率从2018年呈现显著下降,入院病死率与PM_(2.5)、PM_(10.0)、NO_(2)显著相关(P<0.05);出院组与死亡组的年龄、日常生活能力评分(Barthel指数)、住院天数、存在慢性心功能不全、房颤、慢性肾功能不全、低蛋白血症7个变量比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,NO_(2)、房颤、慢性肾功能不全为COPD患者不良预后的独立危险因素(P<0.05),入院时Barthel指数为其保护因素(P<0.05)。受试者工作特征曲线显示,入院时Barthel指数为37.5是不良预后的最佳风险预测截断值,特异度为75.5%,灵敏度为74.5%。结论COPD疾病发展及预后与空气质量及个人卫生防护习惯相关。同时,日常生活能力评分(Barthel指数)可作为疾病风险预测特异性及敏感性均较好的指标,而合并肾功能不全及房颤的COPD患者临床应给予足够重视,避免不良预后。Objective With the improvement of air quality in Beijing and the influence of COVID-19 on the management of chronic respiratory disease and personal hygiene habits,it is necessary to make a retrospective analysis of the trend of change and prognostic factors for hospitalized patients with chronic obstructive pulmonary disease(COPD)in recent years,so as to provide data reference for clinical work.Methods Official website of Beijing Municipal Ecological and Environmental Monitoring Center was used to collect the public data including PM_(2.5),PM_(10.0),sulfur dioxide(SO_(2)),nitrogen dioxide(NO_(2))and the good quality air days in Beijing from 2015 to 2020.A retrospective study was conducted in all hospitalized patients of COPD(1493 cases with or without acute exacerbation/pulmonary infection)diagnosed in Beijing Jishuitan Hospital from January 2015 to December 2020.Results The number of COPD patients admitted to hospital was the most from December to February of the next year,and then decreased gradually,reached the valley value in July.From the perspective of annual change trend,the number of COPD patients admitted to hospital had decreased since 2017 and significantly decreased in 2020.Correlation analysis showed that the number of hospitalized COPD patients was related to the air quality index PM_(2.5)、PM_(10.0),SO_(2),NO_(2) and the good quality air days(P<0.05).There were significant differences in age,activity of daily living score(Barthel index),length of hospital stay,chronic cardiac insufficiency,atrial fibrillation,chronic renal insufficiency and hypoproteinemia between the discharge group and the death group(P<0.05).Multivariate regression analysis showed that high NO_(2),chronic renal insufficiency and atrial fibrillation were independent risk factors for poor prognosis(P<0.05),and Barthel index at admission was protective factor(P<0.05).Receiver operating characteristics(ROC)curve showed that when Barthel index was 37.5 points at admission,the specificity and sensitivity in predicting the risk of po

关 键 词：慢性阻塞性肺疾病 急性加重 入院 空气质量 疾病预后 

分 类 号：R563.9[医药卫生—呼吸系统]