慢性阻塞性肺疾病的合并症/并发症的发病率和病死率分析

doi:10.3877/cma.j.issn.1674-6902.2021.04.003

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (04) : 417 -421. doi: 10.3877/cma.j.issn.1674-6902.2021.04.003

论著

慢性阻塞性肺疾病的合并症/并发症的发病率和病死率分析

陈华萍¹, 甘志新², 刘刚², 刘双林², 刘禹², 焦玉丁², 缪殿南², 徐静², 王关嵩², 徐智², 李琦², 胡明冬¹^,^†(

)

^1. 400037　重庆，陆军（第三）军医大学第二附属医院老年与特勤医学科；400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学中心
^2. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学中心

收稿日期:2021-02-15 出版日期:2021-08-25
通信作者: 胡明冬
基金资助:
陆军军事医学创新工程专项(18CXZ002); 国家科技部重点研发计划项目(2016YFC130453)

Study of morbidity and mortality in chronic obstructive pulmonary disease with co-morbidity and complications

Huaping Chen¹, Zhixin Gan², Gang Liu², Shuanglin Liu², Yu Liu², Yuding Jiao², Diannan Miao², Jing Xu², Guansong Wang², Zhi Xu², Qi Li², Mingdong Hu¹^,^†()

^1. Department of Gerontology and Secret Service Medicine, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China; Department of Respiratory and Critical Care Medicine Center, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
^2. Department of Respiratory and Critical Care Medicine Center, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China

Received:2021-02-15 Published:2021-08-25
Corresponding author: Mingdong Hu

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引用本文：

陈华萍, 甘志新, 刘刚, 刘双林, 刘禹, 焦玉丁, 缪殿南, 徐静, 王关嵩, 徐智, 李琦, 胡明冬. 慢性阻塞性肺疾病的合并症/并发症的发病率和病死率分析[J]. 中华肺部疾病杂志(电子版), 2021, 14(04): 417-421.

Huaping Chen, Zhixin Gan, Gang Liu, Shuanglin Liu, Yu Liu, Yuding Jiao, Diannan Miao, Jing Xu, Guansong Wang, Zhi Xu, Qi Li, Mingdong Hu. Study of morbidity and mortality in chronic obstructive pulmonary disease with co-morbidity and complications[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(04): 417-421.

目的

探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)的合并症/并发症的发病率和病死率。

方法

选择我院呼吸与危重症医学中心2018年1月至2018年12月住院的COPD患者1 210例，按照其合并症/并发症的类型进行分组，以单纯COPD为对照组，其余为病例组，观察各合并症/并发症的发病率和病死率，同时分析各组病例在性别、年龄、病程、吸烟、每年急性加重次数间的差异，以及合并各类疾病的发病率和病死率。

结果

COPD患者中合并症/并发症发病率为98.60%，病死率为1.34%。在COPD患者合并症/并发症发病率分析中，结果显示肺外合并症中以血管系统疾病为主，占36.37%，肺内合并症以肺癌为主，占36.37，并发症中以呼吸衰竭为主，占20.95%；在病死率分析中结果显示合并心血管系统疾病、神经系统疾病、血液系统、并发呼吸衰竭、肺性脑病病死率较高，其病死率分别为4.25%、4.28%、5.00%、3.60%、6.25%；而合并症/并发症组患者在病程、急性加重次数方面较对照组有不同程度的增加。在COPD合并各系统疾病亚分类发病率和病死率分析中，结果表明COPD合并高血压发病率最高，为25.81%，以COPD合并消化道出血病死率最高，达16.66%。

结论

COPD合并症/并发症患者发病率较高，病死率显著增加，严重影响COPD患者的预后。COPD的诊治中对其合并症/并发症的需要十分重视。

关键词: 肺疾病, 慢性阻塞性, 合并症, 并发症, 发病率, 病死率

Objective

To study the morbidity and mortality of co-morbidity and complications in patients with chronic obstructive pulmonary disease (COPD).

Methods

1 210 hospitalized patients with COPD were collected in Department of Respiratory and Critical Care Medicine Center from January 2018 to December 2018 in this study, and they were divided three groups, including COPD group, co-morbidity group and complication group. Meanwhile, the morbidity and mortality were observed, then, compared to different of the sex, age, course, smoking, the number of acute exacerbations per year, and mortality in the three groups.

Results

The morbidity rate of co-morbidity/complications were 98.60%, and the mortality rate was 1.34%, which was significantly increasing than that of the control group(P<0.05). In the analysis of morbidity, the results indicated that the morbidity of cardiovascular diseases was significantly higher than other system disease, which was 36.37%. Secondly, the lung cancer was the highest in COPD with pulmonary disease, also 36.37%. Next, the respiratory failure was most rate in complications, was 20.95%. Otherwise, In the analysis of mortality, results shown that it was high mortality rate in COPD with cardiovascular system diseases, nervous system diseases, blood system diseases, respiratory failure, pulmonary encephalopathy, it was 4.25%, 4.28%, 5.00%, 3.60%, 6.25%. Moreover, there was markedly increasing in course and the number of acute exacerbations per year in co-morbidity/complications group compared to COPD group. Finally, In the analysis of morbidity and mortality in different classification, the result found that the morbidity of hypertension was highest, at 25.81%, however, the mortality of upper gastrointestinal hemorrhage was highest in all diseases, was 16.66%.

Conclusion

The morbidity and mortality of COPD patients with complications are higher, which seriously influenced the treatment and prognosis of disease. Therefore, the co-morbidity and complications of COPD should be paid more attention in clinical work.

Key words: Chronic obstructive pulmonary disease, Co-morbidity, Complications, Morbidity, Mortality

表1 各组患者临床资料

组　别	病例数	性别(男/女)	年龄(岁)	病程(年)	吸烟比例[n(%)]	吸烟时间(年)	急性加重次数[次/年]	发病率[n(%)]	病死率[n(%)]
对照组	17	16/1	70.90±8.56	10.88±6.61	70.58(12)	29.88±20.02	2.18±1.91	1.40	0(0.00)
合并症组	1 193	1 003/190	68.81±9.54	11.40±11.70	74.09(884)	26.72±19.19	3.00±3.00^a	98.60^a	1.34(16)
并发症组	364	299/64	70.22±10.28	15.09±12.47	69.50(253)	25.62±19.44	2.67±4.45^a	30.51^a	2.47(9)

表1 各组患者临床资料

组　别	病例数	性别(男/女)	年龄(岁)	病程(年)	吸烟比例[n(%)]	吸烟时间(年)	急性加重次数[次/年]	发病率[n(%)]	病死率[n(%)]
对照组	17	16/1	70.90±8.56	10.88±6.61	70.58(12)	29.88±20.02	2.18±1.91	1.40	0(0.00)
合并症组	1 193	1 003/190	68.81±9.54	11.40±11.70	74.09(884)	26.72±19.19	3.00±3.00^a	98.60^a	1.34(16)
并发症组	364	299/64	70.22±10.28	15.09±12.47	69.50(253)	25.62±19.44	2.67±4.45^a	30.51^a	2.47(9)

表2 COPD患者合并症和并发症的发病率和病死率比较

分组及疾病谱		例数	性别(男/女)	年龄(岁)	病程(年)	吸烟比例[n(%)]	吸烟时间(年)	急性加重次数[次/年]	发病率[n(%)]	病死率[n(%)]
对照组		17	16/1	70.90±8.56	10.88±6.61	70.58(12)	29.88±20.02	2.18±1.91	1.40	0(0.00)
肺外合并症
	心血管系统	434	341/92	72.43±9.07	13.39±11.68	43.31(188)^a	22.72±19.94	2.76±3.38	36.37	4.25(8)
	消化系统	313	265/47	69.29±9.50	11.70±11.47	72.20(226)	25.86±19.23	2.61±2.73	26.23	2.23(7)
	泌尿系统	220	201/19	72.54±9.57	12.57±11.38	83.64(184)^a	29.35±18.28	3.18±5.01^a	18.44	0.90(2)
	神经系统	140	117/23	70.70±9.5	12.34±12.22	72.86(102)	24.14±18.57	3.21±3.09^a	11.74	4.28(6)^a
	内分泌系统	153	123/30	70.40±9.19	13.67±12.72	71.24(109)	24.42±19.37	3.17±3.71	12.82	1.96(3)
	血液系统	120	94/26	70.81±10.38	11.46±11.14	73.33(88)	26.91±19.89	2.24±2.49	10.06	5.00(6)
	运动系统	45	27/18	72.66±9.9	15.86±16.06	48.89(22)^a	22.17±22.58	3.82±5.51^a	3.77	6.66(3)
肺内合并症
	哮喘	69	31/38	64.72±12.24^a	22.81±17.55^a	42.02(29)^a	12.07±16.72^a	2.84±3.46	5.78	0.0
	肺部肿瘤	434	395/39	66.25±7.45	7.49±9.50	83.64(363)^a	31.45±17.79	3.01±2.56^a	36.37	0.0
	支气管扩张	107	72/35	67.88±11.10	19.28±15.79^a	45.79(49)^a	14.95±14.18^a	2.81±3.75	8.97	0.0
	间质性肺病	28	25/3	68.00±9.71	9.55±11.14	78.57(22)	28.92±18.85	1.78±1.98	2.34	0.0
	肺结核	121	104/17	68.32±10.32	9.99±10.89	70.24(85)	24.04±19.17	2.20±2.68	10.14	1.65(2)
	重症肺炎	171	152/19	71.21±9.17	11.40±18.68	78.94(135)	28.38±18.68	2.26±2.42	14.33	5.26(9)
	肺大泡	108	102/6	64.84±10.54^a	10.37±10.94	85.19(92)^a	29.61±15.99	2.49±3.59	9.05	0.0
	胸腔积液	50	39/11	71.42±8.15	11.64±13.16	74.00(37)^a	28.34±20.69	1.96±2.01	4.19	0.0
	睡眠呼吸暂停	8	6/2	66.75±9.64	13.25±8.41	62.5(5)	27.75±24.02	3.50±3.29^a	0.67	0.0
并发症
	呼吸衰竭	250	202/48	70.34±10.28	14.99±12.36	71.20(178)	26.01±19.74	2.91±5.11	20.95^a	3.60(9)^a
	肺源性心脏病	175	132/42	70.56±9.55	17.14±13.57^a	66.28(116)	22.51±19.80	3.00±5.00	14.46^a	1.14(2)^a
	气胸	40	40/0	65.43±9.81^a	13.33±11.36	97.50(39)^a	33.43±12.21	2.02±3.97	3.35	2.50(1)
	肺性脑病	16	15/1	67.06±10.57	11.25±10.87	75.00(12)	23.31±17.11	1.31±0.47	1.34	6.25(1)

表2 COPD患者合并症和并发症的发病率和病死率比较

分组及疾病谱		例数	性别(男/女)	年龄(岁)	病程(年)	吸烟比例[n(%)]	吸烟时间(年)	急性加重次数[次/年]	发病率[n(%)]	病死率[n(%)]
对照组		17	16/1	70.90±8.56	10.88±6.61	70.58(12)	29.88±20.02	2.18±1.91	1.40	0(0.00)
肺外合并症
	心血管系统	434	341/92	72.43±9.07	13.39±11.68	43.31(188)^a	22.72±19.94	2.76±3.38	36.37	4.25(8)
	消化系统	313	265/47	69.29±9.50	11.70±11.47	72.20(226)	25.86±19.23	2.61±2.73	26.23	2.23(7)
	泌尿系统	220	201/19	72.54±9.57	12.57±11.38	83.64(184)^a	29.35±18.28	3.18±5.01^a	18.44	0.90(2)
	神经系统	140	117/23	70.70±9.5	12.34±12.22	72.86(102)	24.14±18.57	3.21±3.09^a	11.74	4.28(6)^a
	内分泌系统	153	123/30	70.40±9.19	13.67±12.72	71.24(109)	24.42±19.37	3.17±3.71	12.82	1.96(3)
	血液系统	120	94/26	70.81±10.38	11.46±11.14	73.33(88)	26.91±19.89	2.24±2.49	10.06	5.00(6)
	运动系统	45	27/18	72.66±9.9	15.86±16.06	48.89(22)^a	22.17±22.58	3.82±5.51^a	3.77	6.66(3)
肺内合并症
	哮喘	69	31/38	64.72±12.24^a	22.81±17.55^a	42.02(29)^a	12.07±16.72^a	2.84±3.46	5.78	0.0
	肺部肿瘤	434	395/39	66.25±7.45	7.49±9.50	83.64(363)^a	31.45±17.79	3.01±2.56^a	36.37	0.0
	支气管扩张	107	72/35	67.88±11.10	19.28±15.79^a	45.79(49)^a	14.95±14.18^a	2.81±3.75	8.97	0.0
	间质性肺病	28	25/3	68.00±9.71	9.55±11.14	78.57(22)	28.92±18.85	1.78±1.98	2.34	0.0
	肺结核	121	104/17	68.32±10.32	9.99±10.89	70.24(85)	24.04±19.17	2.20±2.68	10.14	1.65(2)
	重症肺炎	171	152/19	71.21±9.17	11.40±18.68	78.94(135)	28.38±18.68	2.26±2.42	14.33	5.26(9)
	肺大泡	108	102/6	64.84±10.54^a	10.37±10.94	85.19(92)^a	29.61±15.99	2.49±3.59	9.05	0.0
	胸腔积液	50	39/11	71.42±8.15	11.64±13.16	74.00(37)^a	28.34±20.69	1.96±2.01	4.19	0.0
	睡眠呼吸暂停	8	6/2	66.75±9.64	13.25±8.41	62.5(5)	27.75±24.02	3.50±3.29^a	0.67	0.0
并发症
	呼吸衰竭	250	202/48	70.34±10.28	14.99±12.36	71.20(178)	26.01±19.74	2.91±5.11	20.95^a	3.60(9)^a
	肺源性心脏病	175	132/42	70.56±9.55	17.14±13.57^a	66.28(116)	22.51±19.80	3.00±5.00	14.46^a	1.14(2)^a
	气胸	40	40/0	65.43±9.81^a	13.33±11.36	97.50(39)^a	33.43±12.21	2.02±3.97	3.35	2.50(1)
	肺性脑病	16	15/1	67.06±10.57	11.25±10.87	75.00(12)	23.31±17.11	1.31±0.47	1.34	6.25(1)

表3 COPD合并心血管疾病发病率

分组及疾病谱		病例数	发病率(%)	病死率(%)	分　组		病例数	发病率(%)	病死率(%)
心血管系统		343			泌尿系统		220
	高血压	308	25.81	1.95(6)		前列腺增生	99	8.29	0.99(1)
	冠心病	158	13.24	2.53(4)		肾炎	40	3.35	5.00(2)
	心律失常	18	1.51	0.0		肾结石	34	2.84	0.0
	心脏瓣膜病	9	0.75	0		肾囊肿	123	10.31	1.63(2)
	心肌梗死	5	0.42	0.0		内分泌系统	153
	心绞痛	24	2.01	4.16(1)		糖尿病	139	11.65	2.16(3)
	房颤	6	0.50	0		甲状腺疾病	11	0.92	0.0
	其他心血管疾病	84	7.04	0.0		其他	10	0.83	0.0
消化系统		313			运动系统		45
	慢性胃炎	92	7.71	0.0		颈椎病	9	0.75	0.0
	肝脏疾病	214	17.93	1.87(4)		腰椎间盘突出	9	0.75
	胆道疾病	12	1.00	8.33(1)		骨折	15	1/25	13.33(2)
	消化道出血	24	2.01	16.66(4)		骨质疏松	22	1.84	4.54(1)
神经系统		140			血液系统		120
	脑梗死	80	6.70	3.75(3)		贫血	107	8.96	4.67(5)
	脑动脉供血不足	10	0.83	0.00		血细胞减少	68	5.70	1.79(3)
	肺性脑病	16	1.34	6.25(1)
	帕金森	5	0.42	0.0
	意识障碍	3	0.25	0
	癫痫	4	0.33	0

表3 COPD合并心血管疾病发病率

分组及疾病谱		病例数	发病率(%)	病死率(%)	分　组		病例数	发病率(%)	病死率(%)
心血管系统		343			泌尿系统		220
	高血压	308	25.81	1.95(6)		前列腺增生	99	8.29	0.99(1)
	冠心病	158	13.24	2.53(4)		肾炎	40	3.35	5.00(2)
	心律失常	18	1.51	0.0		肾结石	34	2.84	0.0
	心脏瓣膜病	9	0.75	0		肾囊肿	123	10.31	1.63(2)
	心肌梗死	5	0.42	0.0		内分泌系统	153
	心绞痛	24	2.01	4.16(1)		糖尿病	139	11.65	2.16(3)
	房颤	6	0.50	0		甲状腺疾病	11	0.92	0.0
	其他心血管疾病	84	7.04	0.0		其他	10	0.83	0.0
消化系统		313			运动系统		45
	慢性胃炎	92	7.71	0.0		颈椎病	9	0.75	0.0
	肝脏疾病	214	17.93	1.87(4)		腰椎间盘突出	9	0.75
	胆道疾病	12	1.00	8.33(1)		骨折	15	1/25	13.33(2)
	消化道出血	24	2.01	16.66(4)		骨质疏松	22	1.84	4.54(1)
神经系统		140			血液系统		120
	脑梗死	80	6.70	3.75(3)		贫血	107	8.96	4.67(5)
	脑动脉供血不足	10	0.83	0.00		血细胞减少	68	5.70	1.79(3)
	肺性脑病	16	1.34	6.25(1)
	帕金森	5	0.42	0.0
	意识障碍	3	0.25	0
	癫痫	4	0.33	0

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Study of morbidity and mortality in chronic obstructive pulmonary disease with co-morbidity and complications

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Study of morbidity and mortality in chronic obstructive pulmonary disease with co-morbidity and complications