664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素  

Three-year survival status of 664 older patients with acute exacerbation of chronic obstructive pulmonary disease and the prognostic factors of traditional Chinese and western medicine

作　　者：李书娇 郭园润 王明哲[1] 程淼[1] 梁峰源 李怡秋 班承钧 LI Shujiao;GUO Yuanrun;WANG Mingzhe;CHENG Miao;LIANG Fengyuan;LI Yiqiu;BAN Chengjun(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Beijing University of Chinese Medicine,Beijing 102488,China;School of Statistics,Renmin University of China,Beijing 100044,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]北京中医药大学 [3]中国人民大学统计学院

出　　处：《北京中医药大学学报》2024年第9期1288-1296,共9页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(No.81973784);北京中医药大学东直门医院特殊人才引进科研启动费专项(No.DZM-2018RC02)。

摘　　要：目的慢性阻塞性肺疾病急性加重(AECOPD)是慢性阻塞性肺疾病(COPD)患者住院及死亡的主要原因。探讨AECOPD老年患者的预后影响因素将有助于优化治疗策略和规范疾病管理。方法收集2013年1月—2019年9月,北京中医药大学东直门医院因AECOPD住院的老年患者,电话随访调查36个月内的全因死亡率。根据患者是否死亡,分为死亡组和生存组,比较2组患者的基本情况、合并疾病、辅助检查结果等临床资料。结合研究者临床经验和以往研究证据对变量进行二次筛选,最终确定纳入多因素Cox比例风险回归模型的协变量。探讨影响3年生存率的中西医影响因素。结果本研究共纳入664例,其中男362例、女302例,年龄(77.25±6.89)岁。3年内,136例(20.48%)患者死亡。较大年龄(HR:1.071,95%CI:1.040~1.102,P<0.001);有吸烟史(HR:1.788,95%CI:1.173~2.723,P=0.007);查尔森合并症指数(HR:1.209,95%CI:1.029~1.421,P=0.022);较低的动脉血氧分压(HR:1.014,95%CI:1.006~1.022,P<0.001);较高水平的脑钠肽(HR:1.001,95%CI:1.000~1.001,P=0.025);伴有肺源性心脏病(HR:1.896,95%CI:1.235~2.908,P=0.004);伴有呼吸衰竭(HR:2.437,95%CI:1.378~4.311,P=0.003);病位要素肾(HR:1.639,95%CI:1.055~2.546,P=0.028);病性要素水饮(HR:2.512,95%CI:1.653~3.816,P<0.001)是AECOPD老年住院患者3年全因死亡的独立危险因素。规律使用支气管舒张剂(HR:0.474,95%CI:0.324~0.695,P<0.001)是AECOPD老年住院患者3年全因死亡的独立保护性因素。结论老年AECOPD住院患者3年生存率较低。中医证候要素表现为肺肾气虚、阳虚水泛、瘀血内阻,COPD肺功能中、重度损害以上的患者3年内死亡风险增高。因此,针对此类患者,益肺肾之气、化痰饮水湿、活血祛瘀通络,联合规律使用支气管扩张剂,可能有助于改善此类患者3年生存率。Objective Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is the leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease(COPD).Exploring the prognostic factors of AECOPD patients will assist in optimizing treatment strategies and standardizing disease management.Methods This study retrospectively collected the clinical data of 664 patients with AECOPD admitted to the Respiratory Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2013 to September 2019.The 3-year survival rate and treatment of the patients were investigated.According to whether the patients died,they were divided into a non-survivors group and a survivors group,and clinical data such as basic information,comorbidities,and auxiliary examination results were compared between the two groups.Incorporating clinical experience of researchers and previous research evidence,a secondary screening of variables was conducted to ultimately determine the covariates to be included in the multifactorial Cox proportional hazards regression model,and the factors affecting the 3-year survival rate of the patients were analyzed.Results A total of 664 cases were included in this study,including 362 males and 302 females,with an average age of(77.25±6.89)years old.The 3-year all-cause mortality rate of older hospitalized patients with AECOPD was 20.48%(136 patients).Older age(HR:1.071,95%CI:1.040-1.102,P<0.001);smoking history(HR:1.788,95%CI:1.173-2.723,P=0.007);Charlson comorbidity index(HR:1.209,95%CI:1.029-1.421,P=0.022);lower arterial partial pressure of oxygen(HR:1.014,95%CI:1.006-1.022,P<0.001);higher brain natriuretic peptide(HR:1.001,95%CI:1.000-1.001,P=0.025);cor pulmonale(HR:1.896,95%CI:1.235-2.908,P=0.004);respiratory failure(HR:2.437,95%CI:1.378-4.311,P=0.003);TCM syndrome differentiation elements,including kidney(HR:1.639,95%CI:1.055-2.546,P=0.028)and fluid retention(HR:2.512,95%CI:1.653-3.816,P<0.001),were independent risk factors for 3-year all-cause deat

关 键 词：慢性阻塞性肺疾病急性加重 生存率 真实世界研究 合并疾病 中医证候 

分 类 号：R256.1[医药卫生—中医内科学]