慢性阻塞性肺疾病急性加重期患者心功能不全相关危险因素及其与预后的关系

李路; 杨阳; 孙亚男; 王法财

doi:10.7619/jcmp.20211756

慢性阻塞性肺疾病急性加重期患者心功能不全相关危险因素及其与预后的关系

1.
安徽医科大学附属六安医院, 急诊内科, 安徽六安, 237005
2.
安徽医科大学附属六安医院, 门诊部, 安徽六安, 237005
3.
安徽医科大学附属六安医院, 药学部, 安徽六安, 237005

基金项目:

2020年度安徽医科大学校科研基金项目 2020xkj231

详细信息

中图分类号: R563;R541
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出版历程
- 收稿日期: 2021-04-25
- 网络出版日期: 2021-08-30
- 发布日期: 2021-08-14

Related risk factors of cardiac insufficiency in patients with acute exacerbation of chronic obstructive pulmonary disease and their relationships with prognosis

1.
Emergency Department of Internal Medicine, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, Anhui, 237005
2.
Department of Outpatient, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, Anhui, 237005
3.
Department of Pharmacy, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, Anhui, 237005

摘要

摘要:
目的分析慢性阻塞性肺疾病急性加重期(AECOPD)患者心功能不全相关危险因素及其与预后的关系。
方法选取104例AECOPD患者为研究对象，按照是否合并心功能不全将其分为心功能不全组(n=62)与无心功能不全组(n=42)，以Logistic回归模型分析AECOPD患者心功能不全影响因素及AECOPD患者预后影响因素。
结果心功能不全组与无心功能不全组COPD确诊时间、近1年之内急性加重次数、低白蛋白血症、血二氧化碳分压[p_a(CO₂)]、C反应蛋白(CRP)水平比较，差异有统计学意义(P < 0.05)；p_a(CO₂)、近1年之内急性加重次数、低白蛋白血症是AECOPD患者心功能不全的独立危险因素(P < 0.05)；预后良好组与预后较差组年龄、治疗后红细胞体积分布宽度(RDW)与血清尿酸(UA)、低白蛋白血症、肺功能分级、心功能不全及纽约心脏病学会(NYHA)心功能分级比较，差异有统计学意义(P < 0.05)；年龄、低白蛋白血症、肺功能分级、心功能不全及NYHA心功能分级是AECOPD患者预后的独立危险因素(P < 0.05)。
结论 AECOPD患者心功能不全主要危险因素为p_a(CO₂)升高、近1年之内急性加重次数增多及低白蛋白血症，心功能不全及严重程度与患者预后密切相关，可增高不良预后风险。
- 慢性阻塞性肺疾病急性加重期 /
- 心功能不全 /
- 低白蛋白血症 /
- 预后 /
- 危险因素
Abstract:
Objective To analyze the related risk factors of cardiac insufficiency in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and their relationships with prognosis.
Methods A total of 104 patients with AECOPD were selected as study objects, and were divided into cardiac insufficiency group (n=62) and non-cardiac insufficiency group (n=42) according to the presence or absence of cardiac insufficiency. Logistic regression model was used to analyze the influencing factors of cardiac insufficiency in patients with AECOPD, and the prognostic influencing factors of AECOPD.
Results There were statistically significant differences in the confirmed diagnosis time of COPD, the number of acute exacerbation in the past one year, hypoalbuminemia, partial pressure of carbon dioxide[p_a(CO₂)], and C-reactive protein (CRP) levels between the cardiac insufficiency group and non-cardiac insufficiency group (P < 0.05). The level of p_a(CO₂), the number of acute exacerbation in the past one year, and hypoalbuminemia were independent risk factors for cardiac insufficiency in patients with AECOPD (P < 0.05). There were statistically significant differences in age, red blood cell distribution width (RDW) and serum uric acid (UA) after treatment, pulmonary function classification, hypoalbuminemia, cardiac insufficiency and New York Heart Association (NYHA) cardiac function classification between the good prognosis group and the poor prognosis group (P < 0.05). Age, hypoalbuminemia, pulmonary function classification, cardiac insufficiency and NYHA cardiac function classification were independent risk factors influencing the prognosis of patients with AECOPD (P < 0.05).
Conclusion The main risk factors for cardiac insufficiency in patients with AECOPD include increased p_a(CO₂), increased times of acute exacerbation in the past one year, and hypoalbuminemia. Cardiac insufficiency and its severity are closely related to the patients' prognosis, which can increase the risk of poor prognosis.
- acute exacerbation of chronic obstructive pulmonary disease /
- cardiac insufficiency /
- hypoalbuminemia /
- prognosis /
- risk factor

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表 1 2组临床资料比较(x±s)[n(%)]

临床资料		心功能不全组(n=62)	无心功能不全(n=42)
男性		36(58.06)	19(45.24)
年龄/岁		71.03±8.28	70.93±11.21
吸烟史		43(69.35)	31(73.81)
糖尿病		15(24.19)	9(21.43)
高血压		23(37.10)	13(30.95)
缺血性心脏病		3(4.84)	2(4.76)
肾功能不全		5(8.06)	4(9.52)
房颤		2(3.23)	0
既往用药种类	支气管扩张剂	49(79.03)	31(73.81)
	抗炎药物	26(41.94)	22(52.38)
	其他	7(11.29)	5(11.90)
体质量指数/(kg/m²)		22.78±2.35	23.01±2.34
确诊时间/年		14.68±2.02^*	10.47±1.69
肺功能分级	Ⅰ级	14(22.58)	7(16.67)
	Ⅱ级	27(43.55)	21(50.00)
	Ⅲ级	12(19.35)	9(21.43)
	Ⅳ级	9(14.52)	5(11.90)
动脉血气分析/mmHg	p_a(O₂)	76.07±27.83	72.30±27.50
	p_a(CO₂)	81.84±20.45^*	65.71±18.42
WBC/(×10⁹/L)		9.05±4.56	10.91±6.49
RDW/%	治疗前	15.84±1.69	15.75±2.21
	治疗后	13.07±2.65	12.61±3.23
CRP/(mg/L)		65.78±10.46^*	28.36±5.02
PCT/(ng/mL)		1.49±5.14	6.04±30.87
UA/(μmol/L)	治疗前	348.25±136.75	345.11±135.93
	治疗后	305.75±133.65	269.74±145.30
近1年之内急性加重次数/次		1.89±0.26^*	1.05±0.13
低白蛋白血症		16(25.81)	4(9.52)
神志	清楚	36(58.06)	27(64.29)
	模糊	4(6.45)	4(9.52)
	嗜睡	5(8.06)	2(4.76)
	昏睡	8(12.90)	1(2.38)
	昏迷	9(14.52)	8(19.05)
呼吸频率/(次/min)		22.39±4.02	22.86±4.57
有升压药		8(12.90)	3(7.14)
总住院时间/d		11.16±4.09	11.93±4.41
RDW: 红细胞体积分布宽度; CRP: C反应蛋白; PCT: 降钙素原; UA: 尿酸; p_a(O₂): 血氧分压; p_a(CO₂): 血二氧化碳分压; WBC: 白细胞计数。与无心功能不全组比较, * P＜0.05。

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表 2 AECOPD患者心功能不全Logistic回归分析

因素	单因素分析			多因素分析
因素	OR	95%CI	P	OR	95%CI	P
COPD确诊时间	1.114	0.757~1.639	0.584	1.190	0.954~1.485	0.124
p_a(CO₂)	3.442	1.517~7.809	0.003	3.452	2.588~4.605	＜0.001
CRP	1.149	0.769~1.717	0.498	1.177	0.918~1.510	0.200
近1年之内急性加重次数	4.491	1.394~14.471	0.012	2.863	2.138~3.835	＜0.001
低白蛋白血症	5.018	1.762~14.291	0.003	3.133	2.303~4.262	＜0.001
COPD: 慢性阻塞性肺疾病; p_a(CO₂): 血二氧化碳分压; CRP: C反应蛋白。

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表 3 预后良好组与预后较差组一般资料比较(x±s)[n(%)]

一般资料		预后较差组(n=40)	预后良好组(n=64)
男		17(42.50)	38(59.38)
年龄/岁		73.85±8.09^*	69.20±9.96
吸烟史		32(80.00)	42(65.63)
BMI/(kg/m²)		22.75±2.30	22.95±2.31
糖尿病		13(32.50)	11(17.19)
高血压		14(35.00)	22(34.38)
缺血性心脏病		4(10.00)	1(1.56)
肾功能不全		6(15.00)	3(4.69)
房颤		2(5.00)	0
既往用药种类	支气管扩张剂	32(80.00)	48(75.00)
	抗炎药物	17(42.50)	31(48.44)
	其他	8(20.00)	4(6.25)
住院期间用药种数	≤3种	7(17.50)	12(18.75)
	>3种	33(82.50)	52(81.25)
确诊时间/年		12.74±2.09	13.13±2.04
近1年之内急性加重次数/次		1.57±0.28	1.52±0.26
低白蛋白血症		12(30.00)^*	8(12.50)
神志	清楚	23(57.50)	40(62.50)
	模糊	3(7.50)	5(7.81)
	嗜睡	1(2.50)	6(9.38)
	昏睡	4(10.00)	5(7.81)
	昏迷	9(22.50)	8(12.50)
呼吸频率/(次/min)		22.33±4.55	22.73±4.06
有升压药		6(15.00)	5(7.81)
总住院时间/d		11.03±4.40	11.75±4.11
心功能不全		30(75.00)^*	32(50.00)
NYHA心功能分级	Ⅰ级	3(10.00)^*	15(46.88)
	Ⅱ级	4(13.33)^*	11(34.38)
	Ⅲ级	8(26.67)^*	4(12.50)
	Ⅳ级	15(50.00)^*	2(6.25)
肺功能分级	Ⅰ级	4(10.00)^*	17(26.56)
	Ⅱ级	10(25.00)^*	38(59.38)
	Ⅲ级	15(37.50)^*	6(9.38)
	Ⅳ级	11(27.50)^*	3(4.69)
既往用药依从性	完全依从	21(52.50)	38(59.38)
	部分依从	14(35.00)	26(40.62)
	不依从	5(12.50)	0
住院期间用药依从性	完全依从	25(62.5)	40(62.50)
	部分依从	13(32.50)	24(37.50)
	不依从	2(5.00)	0
BMI: 体质量指数; NYHA: 纽约心脏病协会。与预后良好组比较, * P＜0.05。

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表 4 预后良好组与预后较差组实验室指标比较(x±s)[n(%)]

实验室指标	预后较差组(n=40)	预后良好组(n=64)
p_a(O₂)/mmHg	76.55±27.84	73.30±27.64
p_a(CO₂)/mmHg	73.04±25.76	76.75±17.69
WBC/(×10⁹/L)	10.26±6.74	9.52±4.54
治疗前RDW/%	15.86±2.06	15.77±1.81
治疗后RDW/%	15.90±2.05^*	11.00±1.32
CRP/(mg/L)	51.48±6.81	49.60±6.35
PCT/(ng/mL)	7.22±31.93	0.89±2.75
治疗前UA/(μmol/L)	379.60±164.82	326.59±110.55
治疗后UA/(μmol/L)	395.97±132.83^*	225.73±96.46
p_a(O₂): 血氧分压; p_a(CO₂): 血二氧化碳分压; WBC: 白细胞计数; RDW: 红细胞体积分布宽度; CRP: C反应蛋白; PCT: 降钙素原; UA: 尿酸。与预后良好组比较, * P＜0.05。

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表 5 AECOPD患者预后Logistic回归分析

因素	单因素分析			多因素分析
因素	OR	95%CI	P	OR	95%CI	P
年龄	4.415	2.129~9.153	＜0.001	3.927	3.074~5.018	＜0.001
治疗后RDW	1.225	0.831~1.806	0.306	1.160	0.944~1.424	0.159
治疗后UA	1.929	0.979~3.801	0.058	1.146	0.951~1.380	0.153
低白蛋白血症	5.801	1.711~19.670	0.005	1.195	1.056~1.352	0.005
心功能不全	4.918	1.897~12.750	0.001	3.487	2.558~4.753	＜0.001
NYHA心功能分级	3.615	2.835~4.609	＜0.001	5.323	1.463~19.368	0.012
肺功能分级	3.235	2.463~4.248	＜0.001	6.197	2.642~14.536	＜0.001
RDW: 红细胞体积分布宽度; UA: 尿酸; NYHA: 纽约心脏病协会。

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