>65岁慢性阻塞性肺疾病急性加重合并新型冠状病毒感染患者临床特征  

Clinical characteristics of patients>65 years old with acute exacerbation of chronic obstructive pulmonary disease and COVID-19 infection

作　　者：菅原蓁 吴彩军 李莉 杜佳豪[2] 张爱国[2] 聂智源 孙巧杰 Jian Yuanzhen;Wu Caijun;Li Li;Du Jiahao;Zhang Aiguo;Nie Zhiyuan;Sun Qiaojie(The First Clinical Medical College of Beijing University of Traditional Chinese Medicine,Beijing 100700,China;Department of Emergency,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Institute of Sepsis,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学第一临床医学院,北京100700 [2]北京中医药大学东直门医院急诊科,北京100700 [3]北京中医药大学脓毒症研究所,北京100700

出　　处：《中国医师杂志》2024年第2期166-171,共6页Journal of Chinese Physician

基　　金：国家自然科学基金(82205036);国家中医药管理局计划项目(2023ZYLCYJ02-1)。

摘　　要：目的探讨慢性阻塞性肺疾病急性加重(AECOPD)合并新型冠状病毒感染(COVID-19)患者临床特征。方法收集2022年9月至2023年9月就诊于北京中医药大学东直门医院呼吸科及急诊科>65岁并确诊为AECOPD患者的临床资料,将AECOPD患者分为合并COVID-19组(n=29)和未合并COVID-19组(n=31)。比较两组患者入院时的血小板计数、白细胞计数、淋巴细胞计数、中性粒细胞计数、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、C反应蛋白(CRP)、降钙素原(PCT)、氧分压(PO_(2))、二氧化碳分压(PCO_(2))、D二聚体(D-D)、白介素-6(IL-6)、英国胸科协会改良肺炎评分(CURB-65评分),并对比住院天数、AECOPD分级、死亡结局终点天数。结果合并COVID-19组和未合并COVID-19组的血小板计数、白细胞计数、淋巴细胞计数、中性粒细胞计数、NLR、PLR差异均无统计学意义(均P>0.05),合并COVID-19组的男性比例、CRP、PCO_(2)、D-D、IL-6、CURB-65评分高于未合并COVID-19组,PCT、PO_(2)低于未合并COVID-19组,差异均有统计学意义(均P<0.05)。合并COVID-19组AECOPD分级为Ⅲ级的比例明显高于未合并COVID-19组,且合并COVID-19组病情进展率更高(37.9%vs 22.6%,P<0.05),COVID-19是AECOPD病情进展的独立影响因素。结论>65岁AECOPD合并COVID-19的患者炎症反应更为明显,CRP、IL-6、CURB-65评分可以作为评估炎症程度指标,且AECOPD合并COVID-19者更易出现凝血功能紊乱、低氧血症,病情更为严重,容易进展,提示COVID-19是AECOPD病情进展的独立影响因素。Objective To investigate the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and corona virus disease 2019(COVID-19)infection.Methods Clinical data of AECOPD patients over 65 years old who were diagnosed in the Respiratory and Emergency Departments of the Dongzhimen Hospital,Beijing University of Chinese Medicine from September 2022 to September 2023 were collected.AECOPD patients were divided into a COVID-19 group(n=29)and a non COVID-19 group(n=31).The platelet count,white blood cell count,lymphocyte count,neutrophil count,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),C-reactive protein(CRP),procalcitonin(PCT),partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),D-dimer(D-D),and interleukin-6(IL-6)were compared between two groups of patients upon admission Confusion,Uremia,Respiratory,BP,Age 65 Years(CURB-65)was used to compare length of hospital stay,AECOPD grading,and mortality endpoint days.Results There was no statistically significant difference in platelet count,white blood cell count,lymphocyte count,neutrophil count,NLR,and PLR between the COVID-19 group and the non COVID-19 group(all P>0.05).The proportion of males,CRP,PCO_(2),D-D,IL-6,and CURB-65 scores in the COVID-19 group were higher than those in the non COVID-19 group,while PCT and PO_(2) were lower than those in the non COVID-19 group,with statistically significant difference(all P<0.05).The proportion of AECOPD gradeⅢin the COVID-19 group was significantly higher than that in the non COVID-19 group,and the progression rate of the disease was higher in the COVID-19 group(37.9%vs 22.6%,P<0.05).COVID-19 was an independent influencing factor for the progression of AECOPD.Conclusions Patients over 65 years old with AECOPD infected with COVID-19 have a more pronounced inflammatory response,and CRP,IL-6,and CURB-65 scores can be used as indicators to evaluate the degree of inflammation.AECOPD infected with COVID-19 are more prone to coagula

关 键 词：肺疾病 慢性阻塞性 新型冠状病毒感染 老年人 

分 类 号：R563.9[医药卫生—呼吸系统] R511[医药卫生—内科学]