疲劳对慢性阻塞性肺疾病患者急性加重影响的前瞻性队列研究  

Effect of Fatigue on the Possibility of Acute Exacerbation in COPD:a Prospective Cohort Study

作　　者：方紫妍 李雪儿 杨雪凝 柳静 杨从艳[2] 章凤[3] Akimana Sandra 汪艳 张静 FANG Ziyan;LI Xueer;YANG Xuening;LIU Jing;YANG Congyan;ZHANG Feng;AKIMANA Sandra;WANG Yan;ZHANG Jing(School of Nursing,Bengbu Medical College,Bengbu 233030,China;Department of Nursing,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233017,China;School of Mental Health,Bengbu Medical College,Bengbu 233030,China)

机构地区：[1]蚌埠医学院护理学院,安徽省蚌埠市233030 [2]蚌埠医学院第一附属医院护理部,安徽省蚌埠市233004 [3]蚌埠医学院第一附属医院呼吸与危重症医学科,安徽省蚌埠市233004 [4]蚌埠医学院第二附属医院呼吸与危重症医学科,安徽省蚌埠市233017 [5]蚌埠医学院精神卫生学院,安徽省蚌埠市233030

出　　处：《中国全科医学》2023年第3期287-292,共6页Chinese General Practice

基　　金：安徽省高校人文社会科学研究重大项目(SK2019ZD16);蚌埠医学院研究生科研创新计划项目(Byycx21020)。

摘　　要：背景慢性阻塞性肺疾病(COPD)是常见的呼吸系统疾病,具有高致残率和高致死率的特点。有证据表明疲劳可能诱发COPD急性加重(AECOPD),但尚待进一步研究证实。目的探讨疲劳和AECOPD之间的关系。方法采用便利抽样法选取2019年3月至2020年10月在蚌埠医学院第一附属医院、蚌埠医学院第二附属医院和蚌埠市第三人民医院就诊的597例COPD患者为研究对象。患者入院时收集其性别、年龄、文化程度、婚姻状况、居住方式、合并症、吸烟史、家庭月收入等一般资料,以疲劳量表(FS-14)评估疲劳症状;以BODE指数综合评估病情严重程度及预后状况;分别以医院焦虑抑郁量表(HADS)中的焦虑量表(HADS-A)和抑郁量表(HADS-D)评估焦虑、抑郁状况。患者出院后进行为期1年的跟踪随访,记录AECOPD发生情况,以COPD评估测试量表(CAT)评估生活质量。应用单因素分析和多因素Cox比例风险回归模型分析探究AECOPD发生的影响因素,采用受试者工作特征曲线(ROC曲线)分析疲劳对COPD患者发生急性加重的预测价值。结果经相应纳入标准与排除标准筛选及剔除失访病例,最终纳入的550例COPD患者中,共416例存在疲劳症状(疲劳组),134例无疲劳症状(非疲劳组)。两组患者吸烟史、过去1年AECOPD发生次数、BODE指数、HADS-A评分、CAT评分比较,差异有统计学意义(P<0.05)。多因素Cox比例风险模型回归分析显示疲劳(HR=10.477)、BODE指数3、4级(HR=3.281、15.404)和中度焦虑、重度焦虑(HR=6.551、36.914)是COPD患者发生急性加重的危险因素(P<0.05)。疲劳预测COPD患者发生急性加重的ROC曲线下面积为0.826,灵敏度为85.2%,特异度为65.4%,约登指数为0.506。结论疲劳使COPD患者发生AECOPD的风险增加约10.5倍,临床应开展有针对性的预防干预,减少此类状况发生。Background Chronic obstructive pulmonary disease(COPD)is a common respiratory disease that is associated with high risk of disability and mortality.Although evidence suggests that fatigue may induce acute exacerbation in COPD,it needs to be further tested.Objective To explore the relationship between fatigue and the acute exacerbation in COPD.Methods By use of convenient sampling,a total of 597 COPD patients were selected from the First Affiliated Hospital of Bengbu Medical College,the Second Affiliated Hospital of Bengbu Medical College and the Third People's Hospital of Bengbu to establish a cohort study population between March 2019 and October 2020.During the hospitalization,general information such as gender,age,educational level,marital status,living style,comorbidities,smoking history,and monthly family income were collected from patients.Fatigue Scale-14 was used to measure the fatigue status,BODE index was used to predict the severity and prognosis,Anxiety and depression were assessed by the Anxiety Scale(HADS-A)and the Depression Scale(HADS-D)in the Hospital Anxiety and Depression Scale(HADS).The patients were followed up for 1 year after discharge,recorded the occurrence of acute exacerbation in COPD,and assessed the quality of life with COPD Assessment Test(CAT).Univariate analysis and multivariate Cox regression analysis were performed to identity factors possibly associated with the acute exacerbation in COPD.ROC curve analysis was used to measure the performance of fatigue in predicting acute exacerbation in COPD.Results The lost cases were screened and eliminated according to the corresponding inclusion criteria and exclusion criteria,five hundred and fifty cases were finally included for analysis,416 of them had fatigue,and other 134 did not.Patients with and without fatigue had significant differences in smoking prevalence,mean number of acute exacerbations in a year,BODE index,HADS-A score,and CAT score(P<0.05).Multivariate Cox regression analysis showed that FS-14 score,BODE index and CAT scor

关 键 词：肺疾病 慢性阻塞性 疲劳 前瞻性研究 队列研究 影响因素分析 急性加重 

分 类 号：R563.9[医药卫生—呼吸系统]