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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (04) : 550 -553. doi: 10.3877/cma.j.issn.1674-6902.2023.04.026

临床研究

慢性阻塞性肺疾病急性加重期预后的临床分析
熊锋†(), 娄建丽   
  1. 201599　上海，上海市第六人民医院金山分院急诊科
    201599　上海，上海市第六人民医院金山分院普外科
  • 收稿日期:2023-02-07 出版日期:2023-08-25
  • 通信作者: 熊锋

Clinical analysis of prognosis in acute exacerbation of chronic obstructive pulmonary disease

Feng Xiong†(), Jianli Lou   

  • Received:2023-02-07 Published:2023-08-25
  • Corresponding author: Feng Xiong
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熊锋, 娄建丽. 慢性阻塞性肺疾病急性加重期预后的临床分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 550-553.

Feng Xiong, Jianli Lou. Clinical analysis of prognosis in acute exacerbation of chronic obstructive pulmonary disease[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(04): 550-553.

目的

分析慢性阻塞性肺病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)预后影响因素，建立预测模型。

方法

选择2019年6月至2022年6月我院收治的AECOPD患者79例，将预后不良21例为观察组，58例为对照组，比较两组基础资料、实验室结果等指标，多因素Logistics回归分析。

结果

观察组中13例行有创机械通气，8例住院期间死亡；对照组经治疗后病情平稳，出院1个月后无再次急性发作。两组呼吸频率(25.57±2.40 vs. 23.27±3.89)、嗜酸性粒细胞(113.74±45.79 vs. 162.84±64.41)、血红蛋白(115.26±13.28 vs. 122.56±10.60)、尿素氮(9.91±1.27 vs. 8.67±2.32)、PaCO2(67.19±11.66 vs. 60.01±12.77)、乳酸(2.74±0.74 vs. 2.20±0.65)，P<0.05。多因素Logistics回归发现呼吸频率(OR＝ 0.815，95%CI: 0.681~0.976)、尿素氮(OR＝0.725，95%CI: 0.539~0.977)、PaCO2(OR＝0.945，95%CI: 0.903~0.988)、乳酸(OR＝ 0.380，95%CI: 0.176~0.821)是AECOPD不良预后的危险因素，嗜酸性粒细胞(OR＝1.013，95%CI: 1.002~1.024)、血红蛋白(OR＝1.061，95%CI: 1.009~1.116)是AECOPD预后不良的保护性因素。绘制列线图，预后不良相关因素C-index为0.902(95%CI: 0.856~0.949)，AUC为0.902(95%CI: 0.855~0.950)，平均绝对误差0.053。

结论

呼吸频率、嗜酸性粒细胞、血红蛋白、尿素氮、PaCO2、乳酸等指标是AECOPD患者预后不良的影响因素，早期识别、早期救治重症患者具有临床意义。

关键词: 急性加重期，肺疾病，慢性阻塞性, 预后, 临床分析
表1 两组临床资料比较
临床资料 观察组(n＝21) 对照组(n＝58) 卡方/t值 P值
年龄 76.620±9.206 74.077±8.117 1.333 0.184
性别(男/女) 13/8 39/19 0.195 0.659
吸烟史 18(85.71%) 46(79.31%) 0.411 0.521
呼吸频率(次/min) 25.57±2.40 23.27±3.89 3.807 0.001
白细胞(×109/L) 13.49±1.70 12.69±2.77 1.866 0.070
中性粒细胞(×109/L) 8.06±1.06 7.56±1.28 1.988 0.057
嗜酸性粒细胞(×106/L) 113.74±45.79 162.84±64.41 －3.385 0.001
红细胞(×1012/L) 4.89±0.49 4.74±0.70 1.329 0.193
血小板(×109/L) 210.23±44.38 195.23±54.20 1.421 0.166
血红蛋白(g/L) 115.26±13.28 122.56±10.60 －2.452 0.023
谷草转氨酶(U/L) 36.82±6.70 34.37±8.32 1.538 0.135
谷丙转氨酶(U/L) 36.11±6.51 33.92±9.49 1.369 0.181
白蛋白(g/L) 37.90±4.20 39.35±4.53 －1.468 0.149
碱性磷酸酶(U/L) 85.40±23.68 77.97±27.67 1.327 0.196
血肌酐(μmol/L) 73.61±16.34 66.27±18.91 1.907 0.067
尿素氮(mmol/L) 9.91±1.27 8.67±2.32 2.401 0.017
钙(mmol/L) 2.46±0.12 2.51±0.17 －1.740 0.092
pH 7.39±0.03 7.40±0.03 －1.238 0.226
PaO2(mmHg) 87.83±4.35 89.89±5.44 －1.986 0.057
PaCO2(mmHg) 67.19±11.66 60.01±12.77 2.636 0.014
BE(mmol/L) 0.43±1.53 －0.02±1.65 1.280 0.212
乳酸(mmol/L) 2.74±0.74 2.20±0.65 3.214 0.004
FEV1/FVC% 59.32±5.20 61.04±6.37 －1.395 0.174
表2 不良预后相关指标多元Logistics回归分析
相关因素 β 标准误差 Wald P值 OR 95%置信区间
下限 上限
呼吸频率 －0.204 0.092 4.941 0.026 0.815 0.681 0.976
嗜酸性粒细胞 －0.130 0.005 5.805 0.016 1.013 1.002 1.024
血红蛋白 0.060 0.026 5.371 0.020 1.061 1.009 1.116
尿素氮 －0.321 0.152 4.469 0.035 0.725 0.539 0.977
PaCO2 －0.057 0.023 6.162 0.013 0.945 0.903 0.988
乳酸 －0.967 0.393 6.058 0.014 0.380 0.176 0.821
常量 7.267 4.244 2.932 － － － －
图1 AECOPD患者预后不良模型列线图
图2 AECOPD患者预后不良模型决策曲线
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