慢阻肺急性加重患者不同共病模式下生命质量MCID风险分析  

Risk analysis of MCID of quality of life in patients with acute exacerbation of chronic obstructive pulmonary disease with different multimorbidity patterns

作　　者：董涛 何航帜 胡晓娟 原一玮 靳婕 赵卉[5] 张岩波 DONG Tao;HE Hang-zhi;HU Xiao-juan;YUAN Yi-wei;JIN Jie;ZHAO Hui;ZHANG Yan-bo(Academy of Medical Sciences,Shanxi Medical University,Taiyuan,Shanxi 030001,China;不详)

机构地区：[1]山西医科大学医学科学院,山西太原030001 [2]山西医科大学公共卫生学院卫生统计学教研室 [3]重大疾病风险评估山西省重点实验室 [4]山西医科大学管理学院医学信息技术教研室 [5]山西医科大学第二医院呼吸与危重症医学科 [6]山西医科大学

出　　处：《现代预防医学》2025年第2期362-368,共7页Modern Preventive Medicine

基　　金：国家自然科学基金(82173631);山西省回国留学人员科研资助项目(2023-109)。

摘　　要：目的研究不同共病模式下慢性阻塞性肺疾病急性加重(AECOPD)患者健康相关生命质量(HRQoL)变化的风险因素。方法纳入2021年9月—2023年9月山西省五所医院的AECOPD患者214例。结合圣乔治呼吸问卷(SGRQ)与其最小临床重要差异(MCID)评估患者的HRQoL。从共病(参考ICD-10编码)切入,基于潜在类别分析(LCA)进行共病模式分层,进而采用有序logistic回归分析不同共病模式下患者出院3个月SGRQ评分变化的风险因素。结果LCA将患者分为“心血管疾病组”和“肺心病低负荷组”。有序logistic回归结果显示出院3个月心血管疾病组BMI偏高(OR=2.96,95%CI:1.09~8.34,P=0.035)和直接胆红素偏高(OR=2.96,95%CI:1.07~8.35,P=0.037)患者具有临床意义的SGRQ评分升高的可能性均是两指标正常患者的2.96倍;肺心病低负荷组直接胆红素偏高(OR=3.25,95%CI:1.35~7.97,P=0.009)和氧饱和度偏低(OR=2.35,95%CI:1.05~5.55,P=0.043)患者具有临床意义的SGRQ评分升高的可能性分别是两指标正常患者的3.25倍和2.35倍。结论不同共病模式的AECOPD患者预后风险因素不同,且无论共病模式如何,直接胆红素偏高都是AECOPD患者HRQoL变化的独立危险因素。此外还应密切关注合并心血管疾病的AECOPD患者出现BMI异常变化。Objective To study the risk factors for health-related quality of life(HRQoL)changes in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)under different multimorbidity patterns.Methods AECOPD patients in five hospitals in Shanxi Province were selected from September 2021 to September 2023,and 214 patients were finally included.The minimal clinically important differences(MCID)of St George’s Respiratory Questionnaire(SGRQ)was combined to assess the HRQoL of the patients.This study started from multimorbidity(refer to ICD-10),multimorbidity patterns stratification was performed based on latent class analysis(LCA),and then ordered logistic regression analysis was used to analyze the risk factors affecting the change of SGRQ score at 3 months after discharge of patients with different multimorbidity patterns.Results Patients were divided into“cardiovascular disease group”and“cor pulmonale low burden group”through potential category analysis.Ordered logistic regression results showed that at 3 months after discharge,the probability of clinically significant increased in SGRQ in patients with high BMI(OR=2.96,95%CI:1.09-8.34,P=0.035)and patients with high direct bilirubin(OR=2.96,95%CI:1.07-8.35,P=0.037)in the cardiovascular disease group were 2.96 times higher than that of normal patients;the probability of clinically significant increased in SGRQ in patients with high direct bilirubin(OR=3.25,95%CI:1.35-7.97,P=0.009)and patients with low oxygen saturation(OR=2.35,95%CI:1.05-5.55,P=0.043)in the cor pulmonale low burden group were 3.25 and 2.35 times higher than those of normal patients(P<0.05).Conclusion The prognostic risk factors of AECOPD patients with different multimorbidity patterns are different,and regardless of the multimorbidity patterns,high direct bilirubin is an independent risk factor for HRQoL changes in patients with AECOPD.Moreover clinicians should closely detect in the the abnormal changes in BMI in AECOPD patients with cardiovascular disease.

关 键 词：共病模式 慢性阻塞性肺病急性加重 健康相关生命质量 最小临床重要差异 潜在类别分析 有序logistic回归 

分 类 号：R563.9[医药卫生—呼吸系统]