慢性阻塞性肺疾病前期患者急性加重及再住院风险因素分析

doi:10.3877/cma.j.issn.1674-6902.2026.03.002

目的

探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)前期患者急性加重及全因再住院风险因素。

方法

选取2021年10月至2023年10月我院收治的慢性气道疾病患者127例为研究对象，其中符合慢性呼吸道症状且支气管舒张后第1秒用力呼气容积(forced expiratory volume in 1 second, FEV₁)/(forced vital capacity, FVC)≥0.7为观察组49例，支气管舒张后FEV₁/FVC<0.7为对照组78例。收集患者临床资料、胸部影像学指标、实验室检查结果及治疗效果，随访记录急性加重事件及全因再住院风险。采用Cox比例风险模型分析肺功能分类与出院12个月急性加重及全因再住院相关性。

结果

观察组较对照组慢性阻塞性肺疾病评估测试(COPD assessment test, CAT)评分[(17.28±5.67)比(19.75±6.03)，P＝0.021]、动脉血氧分压(arterial partial pressure of oxygen, PaO₂)[(84.16±14.88) mmHg比(77.85±16.24) mmHg，P＝0.025]、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide, PaCO₂)[(41.08±9.45) mmHg比(44.92±11.53) mmHg，P＝0.044]。观察组使用糖皮质激素[30例(61.22%)比62例(79.49%)，P＝0.022]；吸入支气管扩张剂[28例(57.14%)比59例(75.64%)，P＝0.025]；甲基黄嘌呤类[26例(53.06%)比59例(75.64%)，P＝0.007]；抗生素[36例(73.47%)比70例(89.74%)，P＝0.012]。两组胸部影像学及实验室指标差异无统计学意义(P>0.05)。随访期间，观察组急性加重6例(12.24%，95%CI：8.55~18.65)，对照组15例(19.25%，95%CI：14.70~23.48)(P<0.05)；观察组全因再住院5例(10.20%)，95%CI：9.80~13.89，对照组12例(15.38%)，95%CI：14.12~16.75(P<0.05)。多因素Cox回归分析显示，FEV₁/FVC<0.7是出院12个月发生急性加重(HR＝1.925，95%CI：1.138~3.102，P<0.001)和全因再住院(HR＝2.488，95%CI：1.685~3.615，P<0.001)的危险因素。

结论

COPD前期患者存在急性加重及再住院风险；COPD确诊患者气流受限明确，中期急性加重及再住院风险高于COPD前期患者。临床应重视COPD前期规范随访、危险因素控制和肺功能动态监测，以降低再住院风险具有意义。

关键词: 肺疾病，慢性阻塞性, 气流受限, 肺功能, 评估测试, 全因再住院

Objective

To investigate the risk of acute exacerbations and all-cause readmission in patients with pre-chronic obstructive pulmonary disease (COPD).

Methods

A total of 127 patients with chronic airway diseases admitted to our hospital from October 2021 to October 2023 were selected. Among them, 49 patients with chronic respiratory symptoms and post-bronchodilator forced expiratory volume in 1 second (FEV₁)/forced vital capacity (FVC) ≥ 0.7 were assigned to the observation group, and 78 patients with post-bronchodilator FEV₁/FVC<0.7 were assigned to the control group. Clinical data, chest imaging findings, laboratory results, and treatment details were collected. Acute exacerbation events and all-cause readmissions were recorded during follow-up. A Cox proportional hazards model was used to analyze the association between lung function classification and acute exacerbations as well as all-cause readmission within 12 months after discharge.

Results

Compared with the control group, the observation group had lower COPD assessment test (CAT) scores [(17.28±5.67) vs. (19.75±6.03), P=0.021], higher arterial partial pressure of oxygen (PaO₂) [(84.16±14.88) mmHg vs. (77.85±16.24) mmHg, P=0.025], and lower arterial partial pressure of carbon dioxide (PaCO₂) [(41.08±9.45) mmHg vs. (44.92±11.53) mmHg, P=0.044]. The observation group also had lower usage rates of glucocorticoids [30(61.22%) vs. 62(79.49%), P=0.022], inhaled bronchodilators [28(57.14%) vs. 59(75.64%), P=0.025], methylxanthines [26(53.06%) vs. 59(75.64%), P=0.007], and antibiotics [36(73.47%) vs. 70(89.74%), P=0.012]. No significant differences were found in chest imaging or laboratory indicators between the two groups (P>0.05). During follow-up, the observation group had 6 cases of acute exacerbation (12.24%, 95%CI: 8.55~18.65) and the control group had 15 cases (19.25%, 95%CI: 14.70~23.48) (P<0.05); the observation group had 5 cases of all-cause readmission (10.20%, 95%CI: 9.80~13.89) and the control group had 12 cases (15.38%, 95%CI: 14.12~16.75) (P<0.05). Multivariate Cox regression analysis showed that FEV₁/FVC<0.7 was a risk factor for acute exacerbation (HR=1.925, 95%CI: 1.138~3.102, P<0.001) and all-cause readmission (HR=2.488, 95%CI: 1.685~3.615, P<0.001) within 12 months after discharge.

Conclusion

Patients with pre-COPD have a risk of acute exacerbations and readmission. Patients with confirmed COPD have definite airflow limitation, and their medium-term risks of acute exacerbation and readmission are higher than those of pre-COPD patients. Clinical attention should be paid to standardized follow-up, risk factor control, and dynamic monitoring of lung function in pre-COPD patients to reduce the risk of adverse outcomes.

Key words: Chronic obstructive pulmonary disease, Airflow limitation, Lung function, Assessment test, All-cause readmission

表1 两组慢性气道疾病患者临床资料结果比较

临床资料	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
性别(男/女)	29/20	55/23	4.127	0.042
吸烟史[n(%)]	22(44.90)	51(65.38)	8.763	0.013
合并症[n(%)]
哮喘	3(6.12)	13(16.67)	3.912	0.048
高血压	18(36.73)	25(32.05)	0.315	0.575
冠心病	11(22.45)	9(11.54)	4.125	0.042
糖尿病	6(12.24)	8(10.26)	0.125	0.724
胃食管反流病	9(18.37)	17(21.79)	0.234	0.629
临床症状[n(%)]
咳嗽加剧	28(57.14)	48(61.54)	0.253	0.615
痰量增加	16(32.65)	32(41.03)	0.892	0.345
咳脓痰	13(26.53)	40(51.28)	7.962	0.005
气短	28(57.14)	67(85.90)	13.781	0.000
12个月急性加重[n(%)]
≥2次	11(22.45)	20(25.64)	0.174	0.677
≥1次	20(40.82)	31(39.74)	0.015	0.903
CAT评分(±s)	17.28±5.67	19.75±6.03	2.341	0.021
动脉血气分析(±s)
pH	7.40±0.12	7.41±0.10	0.512	0.609
PaO₂(mmHg)	84.16±14.88	77.85±16.24	2.268	0.025
PaCO₂(mmHg)	41.08±9.45	44.92±11.53	2.038	0.044
使用药物[n(%)]
糖皮质激素	30(61.22)	62(79.49)	5.217	0.022
吸入支气管扩张剂	28(57.14)	59(75.64)	5.014	0.025
甲基黄嘌呤类	26(53.06)	59(75.64)	7.392	0.007
抗生素	36(73.47)	70(89.74)	6.259	0.012
FEV₁预测值%[M(P₂₅，P₇₅)]	70.18(48.36，92.45)	43.25(32.17，60.14)	4.912	0.000
住院时间[d, M(P₂₅，P₇₅)]	10.00(7.00，13.00)	10.00(8.00，14.00)	1.534	0.125

表1 两组慢性气道疾病患者临床资料结果比较

临床资料	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
性别(男/女)	29/20	55/23	4.127	0.042
吸烟史[n(%)]	22(44.90)	51(65.38)	8.763	0.013
合并症[n(%)]
哮喘	3(6.12)	13(16.67)	3.912	0.048
高血压	18(36.73)	25(32.05)	0.315	0.575
冠心病	11(22.45)	9(11.54)	4.125	0.042
糖尿病	6(12.24)	8(10.26)	0.125	0.724
胃食管反流病	9(18.37)	17(21.79)	0.234	0.629
临床症状[n(%)]
咳嗽加剧	28(57.14)	48(61.54)	0.253	0.615
痰量增加	16(32.65)	32(41.03)	0.892	0.345
咳脓痰	13(26.53)	40(51.28)	7.962	0.005
气短	28(57.14)	67(85.90)	13.781	0.000
12个月急性加重[n(%)]
≥2次	11(22.45)	20(25.64)	0.174	0.677
≥1次	20(40.82)	31(39.74)	0.015	0.903
CAT评分(±s)	17.28±5.67	19.75±6.03	2.341	0.021
动脉血气分析(±s)
pH	7.40±0.12	7.41±0.10	0.512	0.609
PaO₂(mmHg)	84.16±14.88	77.85±16.24	2.268	0.025
PaCO₂(mmHg)	41.08±9.45	44.92±11.53	2.038	0.044
使用药物[n(%)]
糖皮质激素	30(61.22)	62(79.49)	5.217	0.022
吸入支气管扩张剂	28(57.14)	59(75.64)	5.014	0.025
甲基黄嘌呤类	26(53.06)	59(75.64)	7.392	0.007
抗生素	36(73.47)	70(89.74)	6.259	0.012
FEV₁预测值%[M(P₂₅，P₇₅)]	70.18(48.36，92.45)	43.25(32.17，60.14)	4.912	0.000
住院时间[d, M(P₂₅，P₇₅)]	10.00(7.00，13.00)	10.00(8.00，14.00)	1.534	0.125

表2 两组慢性气道疾病患者胸部影像学结果

影像学特征	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
肺气肿Goddard评分[分，(±s)]	6.75±2.05	7.85±3.55	1.397	0.165
LAA%-950[%，(±s)]	16.35±5.70	19.65±6.05	1.677	0.096
Pi10[mm, (±s)]	3.86±0.45	3.95±0.51	1.048	0.297
气道壁增厚[n(%)]	24(48.98)	46(58.97)	1.205	0.272
马赛克灌注/气体潴留[n(%)]	17(34.69)	35(44.87)	1.316	0.251
局灶性支气管扩[n(%)]	9(18.37)	20(25.64)	0.928	0.335

表2 两组慢性气道疾病患者胸部影像学结果

影像学特征	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
肺气肿Goddard评分[分，(±s)]	6.75±2.05	7.85±3.55	1.397	0.165
LAA%-950[%，(±s)]	16.35±5.70	19.65±6.05	1.677	0.096
Pi10[mm, (±s)]	3.86±0.45	3.95±0.51	1.048	0.297
气道壁增厚[n(%)]	24(48.98)	46(58.97)	1.205	0.272
马赛克灌注/气体潴留[n(%)]	17(34.69)	35(44.87)	1.316	0.251
局灶性支气管扩[n(%)]	9(18.37)	20(25.64)	0.928	0.335

表3 两组慢性气道疾病患者实验室指标结果

实验室指标	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
白细胞计数[×10⁹/L，(±s)]	9.05±3.15	9.75±3.48	1.142	0.256
中性粒细胞比例[%，(±s)]	73.65±12.05	76.35±11.30	1.302	0.196
嗜酸粒细胞计数[×10⁹/L，(±s)]	0.17±0.08	0.15±0.07	0.935	0.352
血红蛋白[g/L，(±s)]	132.20±17.15	129.50±18.05	0.845	0.400
hs-CRP[mg/L，M(Q₂₅，Q₇₅)]	18.20(10.15，31.05)	22.85(13.10，37.20)	1.548	0.122
PCT[ng/ml, M(Q₂₅，Q₇₅)]	0.17(0.08，0.41)	0.24(0.11，0.56)	1.278	0.201
白蛋白[g/L，(±s)]	38.70±4.85	37.60±5.05	1.218	0.226
D-dimer[mg/L, M(Q₂₅，Q₇₅)]	0.67(0.38，1.10)	0.75(0.45，1.32)	1.084	0.279

表3 两组慢性气道疾病患者实验室指标结果

实验室指标	观察组(n＝49)	对照组(n＝78)	Z/t/χ²值	P值
白细胞计数[×10⁹/L，(±s)]	9.05±3.15	9.75±3.48	1.142	0.256
中性粒细胞比例[%，(±s)]	73.65±12.05	76.35±11.30	1.302	0.196
嗜酸粒细胞计数[×10⁹/L，(±s)]	0.17±0.08	0.15±0.07	0.935	0.352
血红蛋白[g/L，(±s)]	132.20±17.15	129.50±18.05	0.845	0.400
hs-CRP[mg/L，M(Q₂₅，Q₇₅)]	18.20(10.15，31.05)	22.85(13.10，37.20)	1.548	0.122
PCT[ng/ml, M(Q₂₅，Q₇₅)]	0.17(0.08，0.41)	0.24(0.11，0.56)	1.278	0.201
白蛋白[g/L，(±s)]	38.70±4.85	37.60±5.05	1.218	0.226
D-dimer[mg/L, M(Q₂₅，Q₇₅)]	0.67(0.38，1.10)	0.75(0.45，1.32)	1.084	0.279

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Risk analysis of exacerbations and readmission in patients with pre-chronic obstructive pulmonary disease

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Risk analysis of exacerbations and readmission in patients with pre-chronic obstructive pulmonary disease