CAJ | 학술논문

目的探讨是否合并肺炎及英国胸科协会改良肺炎评分(CURB-65评分)对慢性阻塞性肺疾病(简称慢阻肺)急性加重期患者早期病死率的临床评估价值.方法选取东南大学附属中大医院呼吸科2010年1月至2012年9月因慢阻肺急性加重入院483例患者,其中男295例,女188例,年龄45 ～ 92岁.根据入院时胸部影像学检查结果及肺炎诊断标准分为合并肺炎组和不合并肺炎组,以患者入住呼吸科即刻为研究起点,以30 d为研究终点,比较CURB-65评分相同的两组患者住院病死率和30 d病死率；按照CURB-65评分将患者进行分层,比较相同分层的两组患者住院病死率和30 d病死率及各组内不同CURB-65评分患者的住院病死率和30 d病死率.应用受试者工作特征(ROC)曲线评价CURB-65评分对慢阻肺急性加重患者30 d病死率的评估价值.计数资料采用x2检验,计量资料采用t检验,多组间比较采用方差分析.结果本研究纳入457例,其中男278例,女179例,平均年龄(75±9)岁；合并肺炎组120例(26.3％),不合并肺炎组337例(73.7％).合并肺炎组住院期间需要辅助通气者59例(49.2％),住院病死率为18.3％ (22/120),30 d病死率为21.7％(26/120),均显著高于不合并肺炎组[91例(27.0％)、4.7％(16/337)和7.4％(25/337)],差异均有统计学意义(x2值为18.1 ～21.4,均P＜0.01).低、中、高危险程度的住院病死率:合并肺炎组分别为4.4％(2/45)、15.2％(7/46)和44.8％(13/29),不合并肺炎组分别为0.9％ (1/113)、3.4％(4/119)和10.5％ (11/105)；30 d病死率:合并肺炎组分别为4.4％ (2/45)、19.6％ (9/46)和51.7％(15/29),不合并肺炎组分别为0.9％ (1/113)、5.0％ (6/119)和17.1％ (18/105),两组比较,中、高危险程度的差异均有统计学意义(x2值为5.8～10.1,P＜0.05和P＜0.01).用CURB-65评分评估慢阻肺急性加重患者30 d病死率的ROC曲线下面积为0.744(95％ CI为0.674 ～0.814).结论合并肺炎是慢阻肺急性加重患者需要辅助通气及住院死亡的预后因素,CURB-65评分对慢阻肺急性加重患者早期病死率有较好的临床评估价值. 目的探討是否閤併肺炎及英國胸科協會改良肺炎評分(CURB-65評分)對慢性阻塞性肺疾病(簡稱慢阻肺)急性加重期患者早期病死率的臨床評估價值.方法選取東南大學附屬中大醫院呼吸科2010年1月至2012年9月因慢阻肺急性加重入院483例患者,其中男295例,女188例,年齡45 ～ 92歲.根據入院時胸部影像學檢查結果及肺炎診斷標準分為閤併肺炎組和不閤併肺炎組,以患者入住呼吸科即刻為研究起點,以30 d為研究終點,比較CURB-65評分相同的兩組患者住院病死率和30 d病死率；按照CURB-65評分將患者進行分層,比較相同分層的兩組患者住院病死率和30 d病死率及各組內不同CURB-65評分患者的住院病死率和30 d病死率.應用受試者工作特徵(ROC)麯線評價CURB-65評分對慢阻肺急性加重患者30 d病死率的評估價值.計數資料採用x2檢驗,計量資料採用t檢驗,多組間比較採用方差分析.結果本研究納入457例,其中男278例,女179例,平均年齡(75±9)歲；閤併肺炎組120例(26.3％),不閤併肺炎組337例(73.7％).閤併肺炎組住院期間需要輔助通氣者59例(49.2％),住院病死率為18.3％ (22/120),30 d病死率為21.7％(26/120),均顯著高于不閤併肺炎組[91例(27.0％)、4.7％(16/337)和7.4％(25/337)],差異均有統計學意義(x2值為18.1 ～21.4,均P＜0.01).低、中、高危險程度的住院病死率:閤併肺炎組分彆為4.4％(2/45)、15.2％(7/46)和44.8％(13/29),不閤併肺炎組分彆為0.9％ (1/113)、3.4％(4/119)和10.5％ (11/105)；30 d病死率:閤併肺炎組分彆為4.4％ (2/45)、19.6％ (9/46)和51.7％(15/29),不閤併肺炎組分彆為0.9％ (1/113)、5.0％ (6/119)和17.1％ (18/105),兩組比較,中、高危險程度的差異均有統計學意義(x2值為5.8～10.1,P＜0.05和P＜0.01).用CURB-65評分評估慢阻肺急性加重患者30 d病死率的ROC麯線下麵積為0.744(95％ CI為0.674 ～0.814).結論閤併肺炎是慢阻肺急性加重患者需要輔助通氣及住院死亡的預後因素,CURB-65評分對慢阻肺急性加重患者早期病死率有較好的臨床評估價值.
목적 탐토시부합병폐염급영국흉과협회개량폐염평분(CURB-65평분)대만성조새성폐질병(간칭만조폐)급성가중기환자조기병사솔적림상평고개치.방법 선취동남대학부속중대의원호흡과2010년1월지2012년9월인만조폐급성가중입원483례환자,기중남295례,녀188례,년령45 ～ 92세.근거입원시흉부영상학검사결과급폐염진단표준분위합병폐염조화불합병폐염조,이환자입주호흡과즉각위연구기점,이30 d위연구종점,비교CURB-65평분상동적량조환자주원병사솔화30 d병사솔；안조CURB-65평분장환자진행분층,비교상동분층적량조환자주원병사솔화30 d병사솔급각조내불동CURB-65평분환자적주원병사솔화30 d병사솔.응용수시자공작특정(ROC)곡선평개CURB-65평분대만조폐급성가중환자30 d병사솔적평고개치.계수자료채용x2검험,계량자료채용t검험,다조간비교채용방차분석.결과 본연구납입457례,기중남278례,녀179례,평균년령(75±9)세；합병폐염조120례(26.3％),불합병폐염조337례(73.7％).합병폐염조주원기간수요보조통기자59례(49.2％),주원병사솔위18.3％ (22/120),30 d병사솔위21.7％(26/120),균현저고우불합병폐염조[91례(27.0％)、4.7％(16/337)화7.4％(25/337)],차이균유통계학의의(x2치위18.1 ～21.4,균P＜0.01).저、중、고위험정도적주원병사솔:합병폐염조분별위4.4％(2/45)、15.2％(7/46)화44.8％(13/29),불합병폐염조분별위0.9％ (1/113)、3.4％(4/119)화10.5％ (11/105)；30 d병사솔:합병폐염조분별위4.4％ (2/45)、19.6％ (9/46)화51.7％(15/29),불합병폐염조분별위0.9％ (1/113)、5.0％ (6/119)화17.1％ (18/105),량조비교,중、고위험정도적차이균유통계학의의(x2치위5.8～10.1,P＜0.05화P＜0.01).용CURB-65평분평고만조폐급성가중환자30 d병사솔적ROC곡선하면적위0.744(95％ CI위0.674 ～0.814).결론 합병폐염시만조폐급성가중환자수요보조통기급주원사망적예후인소,CURB-65평분대만조폐급성가중환자조기병사솔유교호적림상평고개치.
Objective To investigate the value of coexisting pneumonia and British Thoracic Society CURB-65 score in predicting early mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods In this prospective study,483 consecutive in-patients with AECOPD were recruited between January 2010 and September 2012,including 295 males and 188 females.The patients were aged 45 to 92 years.They were divided into 2 groups:non-pneumonia (npAECOPD) and with pneumonia (pAECOPD).The start point of this study was the date when the patients were admitted into the respiratory ward,and the endpoint was the 30 day mortality.Clinical and demographic data were collected for all the patients,and the value of coexisting pneumonia and CURB-65 in predicting in-hospital mortality and 30 day mortality were assessed and compared.Results According to the inclusion/exclusion criteria,eventually 457 patients were included in this research,with 278 males and 179 females,and an average age of (75 ±9) years.Of the 457 patients,120 (26.3％) patients were in the pAECOPD group and 337 (73.7％) patients in the npAECOPD group.The in-hospital mortality,the 30 day mortality and the assisted ventilation rate were significantly higher in the pAECOPD group as compared to the npAECOPD group 18.3％ (22/120) vs 4.7％ (16/337),21.7％ (26/120) vs 7.4％ (25/337) ; 49.2％ (59/120) vs 27.0％ (91/337),x2 =18.1-21.4,all P ＜0.05,respectively.Furthermore,the in-hospital mortality of the pAECOPD patients with CURB-65 score ＜2,=2 and ＞2 was 4.4％ (2/45),15.2％ (7/46) and 44.8％ (13/29),respectively,while that of the npAECOPD patients was 0.9％ (1/113),3.4％ (4/119) and 10.5％ (11/105),respectively.The 30 day mortality of the pAECOPD patients with CURB-65 score ＜2,=2 and ＞2 was 4.4％ (2/45),19.6％ (9/46) and 51.7％ (15/29),respectively,while that of the npAECOPD patients was 0.9％ (1/113),5.0％ (6/119) and 17.1％ (18/105),respectively.Stratified by CURB-65 Score,the in-hospital and 30 day mortality were both significantly higher in the pAECOPD group than in the npAECOPD group when CURB-65 was ≥2 (x2 =5.8-10.1,P ＜ 0.05 and P ＜0.01,respectively).The AUROC analysis of CURB-65 as a predictor for early mortality resulted in an area under curve of 0.744.Conclusions In patients with AECOPD,coexisting pneumonia is not only a risk factor for in-hospital mortality,but also a predictor for the treatment of assisted ventilation.CURB-65 score may be a good predictor for early mortality in patients with AECOPD.