尘肺病患者发生慢性肺心病的危险因素分析  

Analysis of Risk Factors of Chronic Pulmonary Heart Disease in Patients With Pneumoconiosis

作　　者：陈晴 张鹏 陈叙汐[2,4] 邹雁秋 廖加强 张勤 彭莉君[2,5,6] 兰亚佳[1,2,6] 姚于勤 何秋蓉 CHEN Qing;ZHANG Peng;CHEN Xuxi;ZOU Yanqiu;LIAO Jiaqiang;ZHANG Qin;PENG Lijun;LAN Yajia;YAO Yuqin;HE Qiurong(Department of Occupational and Environmental Health,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;West China Occupational Pneumoconiosis Cohort Study(WCOPCS)Work Group,Chengdu 610041,China;Department of Epidemiology and Health Statistics,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;Department of Health Toxicology and Pathology,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;Department of Respiratory Medicine,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China;West China-PUMC C.C.Chen Institute of Health,Chengdu 610041,China;Clinical Laboratory,West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西公共卫生学院/四川大学华西第四医院劳动卫生与环境卫生学系,成都610041 [2]华西职业性尘肺病队列工作组,成都610041 [3]四川大学华西公共卫生学院/四川大学华西第四医院流行病与卫生统计学系,成都610041 [4]四川大学华西公共卫生学院/四川大学华西第四医院卫生毒理与病理学系,成都610041 [5]四川大学华西公共卫生学院/四川大学华西第四医院呼吸内科,成都610041 [6]华西-协和陈志潜卫生健康研究院职业病防治研究中心,成都610041 [7]四川大学华西公共卫生学院/四川大学华西第四医院检验科,成都610041

出　　处：《四川大学学报（医学版）》2024年第1期167-175,共9页Journal of Sichuan University(Medical Sciences)

基　　金：国家自然科学基金项目(No.U22A20359、No.82373548、No.81773375);四川省自然科学基金项目(No.2023NSFSC0647、No.2023NSFSC0649);四川大学医学交叉重点项目资助。

摘　　要：目的探究尘肺病患者发生慢性肺心病的危险因素。方法收集2012年1月1日–2021年11月30日在四川省某职业病医院住院的尘肺病患者病历资料,采用乘积极限法(K-M)曲线评估患者肺心病发病曲线,采用Cox比例风险回归模型分析尘肺患者发生慢性肺心病的影响因素。结果本研究共纳入885例尘肺患者,随访时间12~115个月,中位随访时间43个月,共有138例患者发生了慢性肺心病,发病密度为38.50/1000人年。多因素Cox比例风险回归分析显示,年龄在50岁及以上〔风险比(hazards ratio,HR)=1.85,95%置信区间(confidence interval,CI):1.25~2.74〕、尘肺叁期(HR=2.43,95%CI:1.48~4.01)、静息心率≥100 min^(−1)(HR=2.62,95%CI:1.63~4.21)、合并慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)(HR=4.52,95%CI:2.12~9.63)、体质量过低(HR=2.40,95%CI:1.48~3.87)、超重及肥胖(HR=0.54,95%CI:0.34~0.86)和三酰甘油(HR=0.69,95%CI:0.49~0.99)是住院患者发生慢性肺心病的影响因素。结论年龄大、叁期尘肺、高静息心率、低BMI、合并COPD都是尘肺患者发生慢性肺心病的危险因素,超重及肥胖、三酰甘油是其保护因素,早期识别危险因素并采取相应的预防措施是预防尘肺患者发生慢性肺心病的关键。Objective To explore the risk factors for developing chronic pulmonary heart disease in patients with pneumoconiosis.Methods The medical records of pneumoconiosis patients admitted to an occupational disease hospital in Sichuan Province between January 2012 and November 2021 were collected.Kaplan-Meier(K-M)method,or product-limit method,was used to plot the incidence curves of pulmonary heart disease in the pneumoconiosis patients.Cox proportional hazard regression model was used to analyze the influencing factors associated with chronic pulmonary heart disease in patients with pneumoconiosis.Results A total of 885 pneumoconiosis patients were included in this study.The follow-up time was 12 to 115 months and the median follow-up time was 43 months.A total of 138 patients developed chronic pulmonary heart disease and the incidence density of pulmonary heart disease was 38.50/1000 personyears.Multivariate Cox proportional hazard regression analysis showed that the influencing factors of pneumoconiosis inpatients developing chronic pulmonary heart disease included the following,being 50 and older(hazard ratio[HR]=1.85,95%confidence interval[CI]:1.25-2.74),stageⅢpneumoconiosis(HR=2.43,95%CI:1.48-4.01),resting heart rate≥100 beats/min(HR=2.62,95%CI:1.63-4.21),the complication of chronic obstructive pulmonary disease(COPD)(HR=4.52,95%CI:2.12-9.63),underweight(HR=2.40,95%CI:1.48-3.87),overweight and obesity(HR=0.54,95%CI:0.34-0.86),and triacylglycerol(TG)(HR=0.69,95%CI:0.49-0.99).Conclusion Old age,stageⅢpneumoconiosis,high resting heart rate,low BMI,and the complication of COPD are risk factors for chronic pulmonary heart disease in pneumoconiosis patients,while overweight and obesity and TG are protective factors.Early identification of the risk factors and the adoption of the corresponding prevention measures are the key to preventing chronic pulmonary heart disease in patients with pneumoconiosis.

关 键 词：尘肺 肺心病 危险因素 回顾性研究 

分 类 号：R541.5[医药卫生—心血管疾病] R135.2[医药卫生—内科学]