上海地区三甲医院频繁与非频繁急性加重稳定期COPD患者的临床特征差异及其临床意义

目的调查并比较上海地区部分三级甲等医院就诊的频繁急性加重组(FE)及非频繁急性加重(NFE)组稳定期COPD患者临床特征差异并分析其临床意义。方法采用多中心、横断面调查方法回顾性分析总结2018年10月至2019年6月在门诊就诊的113例稳定期COPD患者临床症状评分、肺功能水平、血清学指标及合并症分布特征,将患者分为FE组(n=60)和NFE组(n=53),比较2组间上述结果的差异。结果(1)一般特征:患者年龄为(67.84±8.66)岁,2组患者年龄、病程、吸烟指数差异无统计学意义,FE组BMI低于NFE组(22.49±3.32)kg/m2比(24.07±3.58)kg/m2,t=2.431,P=0.017],FE组CAT评分(17.30±7.59)分比(11.38±6.38)分,t=-4.458,P<0.001]、SGRQ评分(37.29±14.82)分比(23.18±12.57)分,t=-5.288,P<0.001]、BODE指数(3.96±1.97)分比(3.05±2.25)分,t=-2.061,P<0.042]、HAMA评分14(12)分比9(8)分,Z=-2.183,P=0.029]及GOLD3-4级患病率(63.6%比43.1%,χ^2=4.473,P=0.034)均高于NFE组,差异有统计学意义。(2)肺功能:FE组吸入支气管扩张剂前FEV1、FEV1%pred、FVC%pred、FEF25-75、FEF25-75%pred、FEF50、FEF50%pred、DLCO%pred低于NFE组分别为(1.14±0.47)L比(1.39±0.64)L,t=2.314,P=0.023;(43.82±16.50)%比(53.13±20.88)%,t=2.534,P=0.013;(69.06±17.85)%比(76.65±19.14)%,t=2.110,P=0.037;(0.49±0.29)L比(0.66±0.40)L,t=2.569,P=0.012;(16.50±8.69)%比(21.81±12.58)%,t=2.723,P=0.008;(0.60±0.41)L比(0.84±0.58)L,t=2.374,P=0.020;(15.97±9.72)%比(22.14±13.91)%,t=2.652,P=0.009;(54.35±21.90)%比(65.20±25.67)%,t=2.133,P=0.036],吸入支气管扩张剂后FEV1/FVC%、FEV1、FEV1%pred、FEF25-75、FEF50%pred均显著低于NFE组分别为(49.38±12.16)%比(55.57±11.71)%,t=2.508,P=0.014;(1.32±0.52)L比(1.57±0.65)L,t=2.059,P=0.042;(50.12±17.18)%比(60.22±20.57)%,t=2.591,P=0.011;(0.59±0.37)L比(0.75±0.42)L,t=2.026,P=0.046;(19.99±12.12)%比(26.23±14.81)%,t=2.242,P=0.027],差异均有统计学意义。(3)血清学指标:FE组血红蛋白浓度显著低于NFE组142(21)g/L比148(18)g/L,Z=-2.159,P=0.031]、血清总IgE高于NFE组166(339)U/ml比71(141)U/ml,Z=-2.041,P=0.041],差异有统计学意义。(4)合并症分布特点:113例患者共涉及33种合并症,存在合并症患者比例为87.6%(n=99),按系统分类中合并症发生率排名前三位的疾病分别为心血管系统疾病(52.2%)、过敏性疾病(48.7%)、代谢性疾病(24.8%),组间比较FE组恶性肿瘤发生率显著低于NFE组(11.7%比30.2%,χ^2=5.955,P=0.015),差异有统计学意义。结论上海局部地区COPD频繁急性加重患者营养状态差、临床症状重,可能与BODE指数高、血清总IgE高、肺功能受损更显著有关。

Clinical characteristics and significance of COPD patients with frequent and non-frequent exacerbations in stable stage in Third class and Grade-A hospitals of Shanghai area

Objective To investigate and compare the clinical characteristics of stable chronic obstructive pulmonary disease(COPD)patients in the frequent exacerbation(FE)and non frequent exacerbation(NFE)groups from the several Third class and Grade-A hospitals of Shanghai area,and analyze their clinical significance.Methods The clinical symptoms score,pulmonary lung function results,serum markers and the distribution of comorbidities of 113 patients diagnosed of stable COPD from October 2018 to June 2019 were analyzed and summarized in a retrospective,multicenter and cross-sectional survey.The patients were divided into FE group(n=60)and NFE group(n=53)and compared the differences between the two groups.Results(1)General characteristics:The mean age was(67.84±8.66)years old.There was no significant difference in age,course of disease and smoking exposure between the two groups.BMI in FE group was lower than that of in NFE group(22.49±3.32)kg/m2 vs(24.07±3.58)kg/m2,t=2.431,P=0.017].The CAT score(17.30±7.59)vs(11.38±6.38),t=-4.458,P<0.001],SGRQ score(37.29±14.82)vs(23.18±12.57),t=-5.288,P<0.001],BODE index(3.96±1.97)vs(3.05±2.25),t=-2.061,P<0.042],HAMA score14(12)vs 9(8),Z=-2.183,P=0.029],and the morbidity of GOLD3-4 patients(63.6%vs 43.1%,χ^2=4.473,P=0.034)in FE group were all higher than those of in NFE group,there were significant differences in those results.(2)Pulmonary function:The results of FEV1,FEV1%pred,FVC%pred,FEF25-75,FEF25-75%pred,FEF50,FEF50%pred,DLCO%pred before bronchodilator inhalation in FE group were lower than those of NFE group(1.14±0.47)L vs(1.39±0.64)L,t=2.314,P=0.023;(43.82±16.50)%vs(53.13±20.88)%,t=2.534,P=0.013;(69.06±17.85)%vs(76.65±19.14)%,t=2.110,P=0.037;(0.49±0.29)L vs(0.66±0.40)L,t=2.569,P=0.012;(16.50±8.69)%vs(21.81±12.58)%,t=2.723,P=0.008;(0.60±0.41)L vs(0.84±0.58)L,t=2.374,P=0.020;(15.97±9.72)%vs(22.14±13.91)%,t=2.652,P=0.009;and(54.35±21.90)%vs(65.20±25.67)%,t=2.133,P=0.036 respectivly].The results of FEV1/FVC,FEV1,FEV1%pred,FEF25-75,FEF50%pred after bronchodilator inhalation in FE group were all lower than those of NFE group(49.38±12.16)%vs(55.57±11.71)%,t=2.508,P=0.014;(1.32±0.52)L vs(1.57±0.65)L,t=2.059,P=0.042;(50.12±17.18)%vs(60.22±20.57)%,t=2.591,P=0.011;(0.59±0.37)L vs(0.75±0.42)L,t=2.026,P=0.046;and(19.99±12.12)%vs(26.23±14.81)%,t=2.242,P=0.027 respectivly],there were statistically significant difference in above results.(3)Serum markers:the results of hemoglobin concentration(HGB)in FE group was lower than that of in NFE group142(21)g/L vs 148(18)g/L,Z=-2.159,P=0.031],and the result of serum total IgE was higher than that in NFE group166(339)U/ml vs 71(141)U/ml,Z=-2.041,P=0.041],the difference was statistically significant.(4)Distribution characteristics of comorbidities:There were 33 kinds of comorbidities in the 113 patients,and the proportion of COPD patients with comorbidities was 87.6%(n=99).The top three of the percentage of the comorbidities werecardiovascular system diseases(52.2%),allergic diseases(48.7%)and metabolic diseases(24.8%)separately.The incidence of malignant tumors in FE group was lower than that of in NFE group(11.7%vs 30.2%,χ^2=5.955,P=0.015),the difference was statistically significant.Conclusions The patients in FE group of COPD have poor nutritional status and severe clinical symptoms,which may be associated with high BODE index,high value of total IgE and more severe impairment of lung function.