重型新型冠状病毒肺炎合并慢性阻塞性肺疾病患者临床特征  

Clinical characteristics of severe coronavirus disease 2019 patients with chronic obstructive pulmonary disease

作　　者：梁华英 陆蓉莉[1] 李毅[1] 潘频华[1] LIANG Huaying;LU Rongli;LI Yi;PAN Pinhua(Department of Respiratory Medicine,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸内科,长沙410008

出　　处：《中南大学学报（医学版）》2022年第12期1695-1703,共9页Journal of Central South University ：Medical Science

基　　金：国家重点研发计划(2016YFC1304204);国家自然科学基金(81770080);国家老年疾病临床研究中心项目(湘雅医院)(2020LNJJ05)。

摘　　要：目的:重型新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)老年患者和有慢性呼吸道基础疾病的患者预后较差,而慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)是最常见的慢性呼吸道疾病之一。本研究拟探讨重型COVID-19合并COPD患者的流行病学特征,以期为重型COVID-19的防治提供循证医学证据。方法:回顾性分析2020年1月29日—2020年4月8日华中科技大学附属协和医院西院收治的重型COVID-19患者的临床基线特征、治疗策略、疾病进展及预后等临床资料。结果:共纳入465例重型COVID-19患者,其中男248例(53.3%),女217例(46.7%),中位年龄62.0岁。53例合并有COPD(合并COPD组)。发病时常见症状有发热(78.5%)、干咳(67.1%)、气促(47.3%)和乏力(40.9%)。与未合并COPD组(n=412)相比,合并COPD组(n=53)入院时血氧饱和度较低(90.0%vs 92.0%,P=0.014)。实验室检查显示:合并COPD组表现为较高水平的C反应蛋白、白介素-6、降钙素原、总胆红素、血尿素氮、血肌酐、脂蛋白(a)、超敏肌钙蛋白I和D-二聚体,以及较低水平的血小板、白蛋白和载脂蛋白A-I。合并COPD组的重型COVID-19患者COPD有更高的序贯器官衰竭评估评分[3.0(2.0,3.0)vs 2.0(2.0,3.0),P=0.038]和英国胸科协会改良肺炎评分[1.0(1.0,2.0)vs 1.0(0.0,1.0),P<0.001],且进展为危重型的比例更高(28.3%vs 10.0%,P<0.001),并发症更多,如脓毒症休克(15.1%vs 6.1%,P=0.034)。合并COPD组抗生素治疗(90.6%vs 77.2%,P=0.025)、无创(11.3%vs 1.7%,P<0.001)和有创机械通气(17.0%vs 8.3%,P=0.039)的需求率更高,住院天数差异无统计学意义[35.0(26.5,45.0)vs 31.0(22.0,39.0),P=0.051],但ICU入住率(17.0%vs 7.5%,P=0.021)、住院病死率(15.1%vs 6.1%,P=0.016)更高。Cox比例风险模型分析显示调整年龄和性别[校正危险比(adjusted hazard ratio,AHR)=2.38(1.30~4.37),P=0.005],调整慢性肾脏疾病、高血压和冠心病[AHR=2.63(1.45~4.77),P<0.001],以及调整有统计学意义的实�Objective:Coronavirus disease 2019(COVID-19)in elderly and patients with chronic respiratory diseases(COPD)had a poor prognosis.COPD is one of the most common chronic respiratory diseases.We explore the epidemiological characteristics of patients with severe COVID-19 with COPD patients in order to provide medical evidence for the prevention and treatment of severe COVID-19.Methods:We retrospectively analyzed the clinical baseline characteristics,treatment strategies,disease progression and prognosis of 557 severe COVID-19 patients admitted to the West Court of Union Hospital of Huazhong University of Science and Technology from January 29,2020 to April 8,2020.Results:A total of 465 patients with severe COVID-19 were enrolled in the study,including 248(53.3%)males and 217(46.7%)females.The median age of severe COVID-19 patients was 62.0 years,and 53 patients were complicated with COPD.Common symptoms at the onset included fever(78.5%),dry cough(67.1%),shortness of breath(47.3%)and fatigue(40.9%).Compared with non-COPD patients,patients with COPD had significantly lower levels of SpO_(2) in admission(90.0%vs 92.0%,P=0.014).In terms of laboratory examinations,patients with COPD had higher levels of C-reactive protein,interleukin-6,procalcitonin,total bilirubin,blood urea nitrogen,serum creatinine,lipoprotein(a),high-sensitivity troponin I,and D-dimer,while had lower levels of platelet counts,albumin and apolipoprotein AI.Severe COVID-19 patients with COPD had higher Sequential Organ Failure Assessment scores[3.0(2.0,3.0)vs 2.0(2.0,3.0),P=0.038]and CURB-65 score[1.0(1.0,2.0)vs1.0(0.0,1.0),P<0.001],and a higher proportion of progressing to critical illness(28.3%vs 10.0%,P<0.001)with more complications[e.g.septic shock(15.1%vs 6.1%,P=0.034)],had higher incidence rates of antibiotic therapies(90.6%vs 77.2%,P=0.025),non-invasive(11.3%vs 1.7%,P<0.001)and invasive mechanical ventilation(17.0%vs 8.3%,P=0.039),ICU admission(17.0%vs 7.5%,P=0.021)and death(15.1%vs 6.1%,P=0.016).Cox proportion hazard model was carried out,and t

关 键 词：重型新型冠状病毒肺炎 慢性阻塞性肺疾病 预后 严重急性呼吸综合征冠状病毒2 

分 类 号：R563.9[医药卫生—呼吸系统] R563.1[医药卫生—内科学]