无创正压通气对慢性阻塞性肺疾病-阻塞性睡眠呼吸暂停重叠综合征全因死亡影响的长期随访研究  

A long-term follow-up study of noninvasive positive pressure ventilation on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome

作　　者：岳芳 杨海珍 郝玥影 陈豪 张静怡 胡克[1] Yue Fang;Yang Haizhen;Hao Yueying;Chen Hao;Zhang Jingyi;Hu Ke(Department of Respiratory and Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院呼吸与危重症医学二科,武汉430060

出　　处：《中华结核和呼吸杂志》2023年第4期373-379,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金资助项目(81970082);国家重点研发计划项目(2016YFC1304403)。

摘　　要：目的通过长期随访探讨无创正压通气(NIPPV)对慢性阻塞性肺疾病-阻塞性睡眠呼吸暂停重叠综合征(OVS)患者全因死亡的影响。方法前瞻性纳入OVS患者187例,将之分为NIPPV组和未使用NIPPV组。其中NIPPV组92例,男85例,女7例,年龄47~80(66.5±8.5)岁;未使用NPPV组95例,男89例,女6例,年龄45~79(67.4±7.8)岁。自入组后开始随访,平均随访39(20,51)个月,比较两组患者的全因死亡。结果两组患者基线资料比较差异无显著性(均P>0.05),具有可比性。Kaplan-Meier曲线显示两组全因病死率无差异(log rank P=0.229),但未使用NIPPV组心脑血管疾病病死率更高(分别为15.8%、6.5%,P=0.045)。年龄、体重指数、颈围、PaCO_(2)、FEV_(1)、FEV_(1)占预计值%、中重度OSA(AHI>15次/h)、mMRC、CAT、慢阻肺急性加重次数及住院次数,与OVS患者发生死亡相关(P<0.05)。其中,年龄(HR为1.067,95%CI:1.017~1.119,P=0.008)、FEV_(1)(HR为0.378,95%CI:0.176~0.811,P=0.013)以及慢阻肺急性加重次数(HR为1.298,95%CI:1.102~1.530,P=0.002)是OVS患者死亡的独立危险因素。结论在常规治疗基础上加用NIPPV可降低OVS患者因心脑血管疾病而死亡的风险;OVS死亡患者的气流受限严重,而OSA程度相对较轻;高龄、低FEV_(1)以及慢阻肺急性加重次数是OVS患者死亡独立危险因素。Objective To investigate the effect of noninvasive positive pressure ventilation(NIPPV)on all-cause mortality in patients with chronic obstructive pulmonary disease-obstructive sleep apnea overlap syndrome(OVS)through long-term follow-up.Methods A total of 187 OVS patients were divided into the NIPPV group(n=92)and the non-NIPPV group(n=95).Of these,85 males and 7 females were in the NIPPV group with an average age of(66.5±8.5)years(range 47-80 years);89 males and 6 females were in the non-NIPPV group with an average age of(67.4±7.8)years(range 44-79 years).Follow-up was performed from enrolment with an average duration of 39(20,51)months.The all-cause mortality was compared between the two groups.Result There were no significant differences in their baseline clinical characteristics(all P>0.05),indicating that the data from the two groups were comparable.The Kaplan-Meier curve showed no difference in all-cause mortality between the two groups(log rank P=0.229).However,deaths from cardio-cerebrovascular diseases were higher in the non-NIPPV than in the NIPPV group(15.8%vs.6.5%,P=0.045).Age,BMI,neck circumference,PaCO_(2),FEV_(1),FEV_(1)%,moderate to severe OSA(AHI>15 events/h),mMRC,CAT,number of acute exacerbations of COPD and number of hospitalizations were associated with all-cause death in OVS patients;among which,age(HR 1.067,95%CI 1.017-1.119,P=0.008),FEV_(1)(HR 0.378,95%CI 0.176-0.811,P=0.013),and number of COPD exacerbations(HR 1.298,95%CI 1.102-1.530,P=0.002)were independent risk factors for all-cause mortality in OVS patients.Conclusions The combination of NIPPV and conventional treatment may reduce cardio-cerebrovascular disease-related mortality in OVS patients.The deceased OVS patients had severe airflow limitation and mild to moderate OSA.Old age,low FEV_(1) and COPD exacerbations were independent risk factors for all-cause mortality in OVS patients.

关 键 词：肺疾病 慢性阻塞性 睡眠呼吸暂停 阻塞性 重叠综合征 全因死亡 心脑血管疾病 

分 类 号：R563.9[医药卫生—呼吸系统] R766[医药卫生—内科学]