慢性阻塞性肺疾病患者共病模式系统聚类分析及其对住院费用的影响  

Systematic Cluster Analysis of Comorbidity Patterns in Patients with Chronic Obstructive Pulmonary Disease and the Impact on Hospitalization Costs

作　　者：程卓卓 张睿[1] 徐浩枫 黄君庭 梁子敬[2] 晏平[1] CHENG Zhuozhuo;ZHANG Rui;XU Haofeng;HUANG Junting;LIANG Zijing;YAN Ping(Department of General Practice,the First Affiliated Hospital,Guangzhou Medical University,Guangzhou 510120,China;Department of Emergency Medicine,the First Affiliated Hospital,Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院全科医学科,广东省广州市510120 [2]广州医科大学附属第一医院急诊科,广东省广州市510120

出　　处：《中国全科医学》2025年第17期2127-2133,共7页Chinese General Practice

基　　金：广东省科学技术研究基金项目(C2022101);广州市科技局市校(院)联合资助(登峰医院)项目(202201020454)。

摘　　要：背景慢性阻塞性肺疾病(COPD)患者常伴多种疾病,增加了治疗的复杂性和医疗负担。共病对COPD患者管理的影响深远,但现有研究多集中于单一疾病,缺少对多种共病模式和住院费用的系统分析。目的探讨COPD患者共病特征及多种共病模式,分析不同特征及共病模式对住院费用的影响,为COPD患者的个性化健康管理和资源配置提供依据。方法对广州医科大学附属第一医院2020—2023年住院的5061例COPD患者进行回顾性分析,采用系统聚类分析方法绘制聚类树状图,研究COPD患者的共病模式,并通过多组间比较分析不同模式的基本特征。利用多元线性回归分析探究各共病模式对住院总费用、西药费用和抗菌药物费用的影响。结果COPD患者中共病4343例,共病患病率为85.81%。系统聚类分析发现了6簇共病模式,包括心血管代谢疾病模式、肝肾疾病模式、消化系统疾病模式、关节疾病模式、癌症模式及呼吸系统疾病模式。6簇共病模式患者的性别、年龄、BMI和吸烟史比较,差异有统计学意义(P<0.05)。多元线性回归分析结果显示,BMI、癌症模式和呼吸系统疾病模式对住院总费用、西药费用和抗菌药物费用均有影响(P<0.05),其中呼吸系统疾病模式对住院总费用的影响最大(β=0.125,P<0.001)。结论COPD的共病模式可分为6簇,其中BMI、癌症模式和呼吸系统疾病模式是COPD患者住院费用的主要影响因素。Background Chronic obstructive pulmonary disease(COPD)patients often present with multiple comorbidities,which increase the complexity of treatment and the healthcare of burden.While comorbidities significantly impact the management of COPD patients,existing research primarily focuses on individual comorbidities,lacking systematic analysis of multiple comorbidity patterns and hospitalization costs.Objective To investigate the comorbidity characteristics and patterns in patients with COPD,analyzing how different features and comorbidity patterns affect hospitalization costs.The findings will provide a basis for personalized health management and resource allocation for COPD patients.Methods A retrospective analysis was conducted on 5061 inpatients diagnosed with COPD at the First Affiliated Hospital,Guangzhou Medical University from 2020 to 2023.Systematic clustering analysis was employed to construct dendrograms,identifying comorbidity patterns among COPD patients.Multiple group comparisons were performed to assess the basic characteristics of these patterns,then multiple linear regression analysis was utilized to evaluate the impact of each comorbidity pattern on total hospitalization costs,western medicine costs,and antibacterial medication costs.Results There are a total of 4343 patients with COPD,and the comorbidity was 85.81%.Systematic clustering analysis identified six comorbidity patterns among COPD patients:cardiovascular and metabolic diseases,hepatorenal diseases,digestive system diseases,arthropathy diseases,cancer and respiratory system diseases.There were significant differences in sex,age,BMI and smoking history among patients with 6 comorbidity models(P<0.05).Multiple linear regression analysis revealed that BMI,cancer pattern,and respiratory system diseases pattern all had impacts on total hospitalization costs,western medicine costs and antibacterial medication costs(P<0.05),with the respiratory system diseases pattern having the most substantial impact on total hospitalization costs(β=0.125,P<

关 键 词：慢性阻塞性肺疾病 共病模式 健康管理 住院费用 聚类分析 

分 类 号：R563.9[医药卫生—呼吸系统]