合并慢性阻塞性肺疾病对重症肺炎死亡率的影响以及重症肺炎中医证型分布特点分析  

Effect of the Complication of Chronic Obstructive Pulmonary Disease on Mortality in Severe Pneumonia and Analysis of the Distribution of Traditional Chinese Medicine Syndrome Types in Severe Pneumonia

作　　者：董洪珍[1] 张伟[1] DONG Hong-Zhen;ZHANG Wei(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一附属医院,广东广州510405

出　　处：《广州中医药大学学报》2023年第10期2417-2423,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家中医临床研究基地业务建设科研专项课题(编号:JDZX2012167);广东省中医药局科研项目(编号:20212058)。

摘　　要：【目的】调查重症肺炎住院死亡率的相关危险因素及中医证型分布特点,分析合并慢性阻塞性肺疾病(COPD)对重症肺炎死亡率的影响。【方法】回顾性收集2018年1月1日~2020年12月31日在广州中医药大学第一附属医院呼吸与危重症医学科住院且第一诊断为重症肺炎的431例患者,根据存活情况将患者分为存活组370例和死亡组61例。通过采用单因素分析、多因素分析以及Cox回归分析确定危险因素,制作生存分析曲线,采用Log-rank检验分析曲线间差异是否有统计学意义,并应用phtest检验对95%置信区间(CI)的风险比(HR)进行检验。【结果】(1)中医证型分布方面,在431例重症肺炎患者中,邪陷正脱证64例,热闭心包证69例,痰热壅肺证74例,痰浊阻肺证80例,肺热腑实证69例,气阴两虚证75例。(2)单因素分析结果显示,相对于存活组,死亡组患者的年龄更大,体质量指数(BMI)更低,序贯器官衰竭估计(SOFA)评分、血清尿素氮与血清肌酐比值(BUN/Scr)、男性比例、合并充血性心力衰竭(CHF)和COPD比例以及辨证为邪陷正脱证、热闭心包证的比例更高,而辨证为气阴两虚证的比例更低,差异均有统计学意义(P<0.05或P<0.01)。(3)多因素分析结果显示,性别、合并COPD、SOFA评分、邪陷正脱证和热闭心包证是重症肺炎患者住院死亡率的危险因素,差异均有统计学意义(P<0.05或P<0.01)。(4)经模型1(混杂因素包括年龄、性别、BMI、合并CHF)和模型2(混杂因素包括年龄、性别、BMI、合并CHF、SOFA评分、BUN/Scr、邪陷正脱证、热闭心包证、气阴两虚证)校正后,合并COPD仍有较高的死亡风险,其HR(95%CI)分别为3.1(1.8-5.2)和2.1(1.0-1.2),差异均有统计学意义(P<0.01),且其风险系数并不随时间改变而变化。【结论】合并COPD是影响重症肺炎死亡率的独立危险因素,而辨证为邪陷正脱证、热闭心包证的重症肺炎患者也有着较高的死亡风险。Objective To investigate the risk factors associated with in-hospital mortality in severe pneumonia and the distribution of traditional Chinese medicine(TCM)syndrome types,and to analyze the impact of the complication of chronic obstructive pulmonary disease(COPD)on mortality in severe pneumonia.Methods A retrospective analysis was carried out in 431 patients who were admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January1,2018 to December 31,2020 and had the first diagnosis of severe pneumonia.The patients were divided into survival group(370 patients)and death group(61 patients)according to the survival status.Risk factors were determined by using univariate analysis,multivariate analysis and Cox regression analysis,and then the survivorship curve was established.Log-rank test was used to analyze the significant difference between curves,and Proportional hazards test(PH test)was applied to test the 95%confidence interval(CI)of hazard ratio(HR).Results(1)Among the 431 patients with severe pneumonia,there were 64 cases of pathogenic-qi invasion and healthy-qi collapse syndrome,69 cases of heat blocking the pericardium syndrome,74 cases of phlegm-heat obstructing the lung syndrome,80 cases of turbid phlegm obstructing the lung syndrome,69 cases of lung-heat and fu-organ excess syndrome,and 75 cases of deficiency of both qi and yin syndrome.(2)The results of the univariate analysis showed that the patients in the death group were older,had lower body mass index(BMI),presented higher sequential organ failure assessment(SOFA)scores and blood urea nitrogen to serum creatinine ratio(BUN/Scr),and had larger proportion of the male,higher incidence of the complication of congestive heart failure(CHF)and COPD,and larger proportion of patients with pathogenic-qi invasion and healthy-qi collapse syndrome and heat blocking the pericardium syndrome,while had smaller proportion of patients with deficiency of both qi and yin s

关 键 词：慢性阻塞性肺疾病 重症肺炎 中医证型 邪陷正脱证 热闭心包证 死亡率 

分 类 号：R259.63[医药卫生—中西医结合]