664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素

李书娇; 郭园润; 王明哲; 程淼; 梁峰源; 李怡秋; 班承钧

doi:10.3969/j.issn.1006-2157.2024.09.013

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664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素

临床研究 | 更新时间：2024-10-09

- 664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素
- Three-year survival status of 664 older patients with acute exacerbation of chronic obstructive pulmonary disease and the prognostic factors of traditional Chinese and western medicine
- 北京中医药大学学报 2024年47卷第9期页码：1288-1296
- 作者机构：
  
  1.北京中医药大学东直门医院　北京　100700
  2.北京中医药大学
  3.中国人民大学统计学院
- 作者简介：
  
  李书娇，女，在读博士生
  #班承钧，男，博士，教授，主任医师，博士生导师，主要研究方向：中医药防治肺系疾病，E-mail: A3326@bucm.edu.cn
- 基金信息：
  
  国家自然科学基金项目(81973784);北京中医药大学东直门医院特殊人才引进科研启动费专项(DZM-2018RC02)
- DOI：10.3969/j.issn.1006-2157.2024.09.013
  中图分类号： R256.1
- 纸质出版日期：2024-09-30，
  
  网络出版日期：2024-07-31，
  
  收稿日期：2024-05-07，
- 稿件说明：
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李书娇, 郭园润, 王明哲, 等. 664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素[J]. 北京中医药大学学报, 2024,47(9):1288-1296.

LI Shujiao, GUO Yuanrun, WANG Mingzhe, et al. Three-year survival status of 664 older patients with acute exacerbation of chronic obstructive pulmonary disease and the prognostic factors of traditional Chinese and western medicine[J]. Journal of Beijing University of Traditional Chinese Medicine, 2024,47(9):1288-1296.
李书娇, 郭园润, 王明哲, 等. 664例慢性阻塞性肺疾病急性加重老年患者3年生存状况及中西医预后影响因素[J]. 北京中医药大学学报, 2024,47(9):1288-1296. DOI： 10.3969/j.issn.1006-2157.2024.09.013.

LI Shujiao, GUO Yuanrun, WANG Mingzhe, et al. Three-year survival status of 664 older patients with acute exacerbation of chronic obstructive pulmonary disease and the prognostic factors of traditional Chinese and western medicine[J]. Journal of Beijing University of Traditional Chinese Medicine, 2024,47(9):1288-1296. DOI： 10.3969/j.issn.1006-2157.2024.09.013.

摘要

目的

慢性阻塞性肺疾病急性加重(AECOPD)是慢性阻塞性肺疾病(COPD)患者住院及死亡的主要原因。探讨AECOPD老年患者的预后影响因素将有助于优化治疗策略和规范疾病管理。

方法

收集2013年1月—2019年9月，北京中医药大学东直门医院因AECOPD住院的老年患者，电话随访调查36个月内的全因死亡率。根据患者是否死亡，分为死亡组和生存组，比较2组患者的基本情况、合并疾病、辅助检查结果等临床资料。结合研究者临床经验和以往研究证据对变量进行二次筛选，最终确定纳入多因素Cox比例风险回归模型的协变量。探讨影响3年生存率的中西医影响因素。

结果

本研究共纳入664例，其中男362例、女302例，年龄(77.25±6.89)岁。3年内，136例(20.48%)患者死亡。较大年龄(

：1.071，95%

：1.040～1.102，

0.001)；有吸烟史(

：1.788，95%

：1.173～2.723，

＝0.007)；查尔森合并症指数(

：1.209，95%

：1.029～1.421，

＝0.022)；较低的动脉血氧分压(

：1.014，95%

：1.006～1.022，

0.001)；较高水平的脑钠肽(

：1.001，95%

：1.000～1.001，

＝0.025)；伴有肺源性心脏病(

：1.896，95%

：1.235～2.908，

＝0.004)；伴有呼吸衰竭(

：2.437，95%

：1.378～4.311，

＝0.003)；病位要素肾(

：1.639，95%

：1.055～2.546，

＝0.028)；病性要素水饮(

：2.512，95%

：1.653～3.816，

0.001)是AECOPD老年住院患者3年全因死亡的独立危险因素。规律使用支气管舒张剂(

：0.474，95%

：0.324～0.695，

0.001)是AECOPD老年住院患者3年全因死亡的独立保护性因素。

结论

老年AECOPD住院患者3年生存率较低。中医证候要素表现为肺肾气虚、阳虚水泛、瘀血内阻，COPD肺功能中、重度损害以上的患者3年内死亡风险增高。因此，针对此类患者，益肺肾之气、化痰饮水湿、活血祛瘀通络，联合规律使用支气管扩张剂，可能有助于改善此类患者3年生存率。

Abstract

Objective

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is the leading cause of hospitalization and death in patients with chronic obstructive pulmonary disease(COPD). Exploring the prognostic factors of AECOPD patients will assist in optimizing treatment strategies and standardizing disease management.

Methods

This study retrospectively collected the clinical data of 664 patients with AECOPD admitted to the Respiratory Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2013 to September 2019. The 3-year survival rate and treatment of the patients were investigated. According to whether the patients died

they were divided into a non-survivors group and a survivors group

and clinical data such as basic information

comorbidities

and auxiliary examination results were compared between the two groups. Incorporating clinical experience of researchers and previous research evidence

a secondary screening of variables was conducted to ultimately determine the covariates to be included in the multifactorial Cox proportional hazards regression model

and the factors affecting the 3-year survival rate of the patients were analyzed.

Results

A total of 664 cases were included in this study

including 362 males and 302 females

with an average age of (77.25±6.89) years old. The 3-year all-cause mortality rate of older hospitalized patients with AECOPD was 20.48%(136 patients). Older age (

HR:

1.071

95%

CI:

1.040-1.102

0.001); smoking history (

HR:

1.788

95%

CI:

1.173-2.723

=0.007); Charlson comorbidity index (

: 1.209

95%

CI:

1.029-1.421

=0.022); lower arterial partial pr

essure of oxygen (

HR:

1.014

95%

CI:

1.006-1.022

0.001); higher brain natriuretic peptide(

HR:

1.001

95%

CI:

1.000-1.001

=0.025); cor pulmonale(

HR:

1.896

95%

CI:

1.235-2.908

=0.004); respiratory failure (

HR:

2.437

95%

CI:

1.378-4.311

=0.003); TCM syndrome differentiation elements

including kidney (

HR:

1.639

95%

CI:

1.055-2.546

=0.028) and fluid retention (

HR:

2.512

95%

CI:

1.653-3.816

0.001)

were independent risk factors for 3-year all-cause death of older hospitalized patients with AECOPD. Long-term regular use of bronchiectasis (

HR:

0.474

95%

CI:

0.324-0.695

0.001) was an independent protective factor for 3-year all-cause death.

Conclusion

The 3-year survival rate of elderly hospitalized patients with AECOPD is relatively low

with the TCM syndrome elements manifested as lung-kidney qi deficiency

yang deficiency with water retention

and blood stasis obstruction. Patients with moderate to severe impairment of lung function due to COPD have an increased risk of death within 3 years. Therefore

for such patients

nourishing lung-kidney qi

resolving phlegm and water retention

activating blood circulation to remove blood stasis and dredging collaterals

combined with regular use of bronchodilators

may help improve their 3-year survival rate.

关键词

慢性阻塞性肺疾病急性加重生存率真实世界研究合并疾病中医证候

Keywords

acute exacerbation of chronic obstructive pulmonary diseasesurvival ratereal world researchcomorbiditiespatterns of traditional Chinese medicine

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