慢性阻塞性肺疾病合并肺源性心脏病的危险因素分析及Nomogram模型构建

目的 分析慢性阻塞性肺疾病（COPD）合并肺源性心脏病（下称肺心病）的危险因素,并构建Nomogram预测模型。方法 选择2018年6月至2021年6月绍兴第二医院医共体总院收治的COPD合并肺心病患者52例为观察组,另择同期本院收治的未合并其他并发症的COPD患者52例为对照组。收集临床资料,包括入院24 h血清脑钠肽（BNP）、C反应蛋白、超声心动图参数和动脉血气分析结果。采用多因素logistic回归分析肺心病的危险因素,据此建立Nomogram模型,评估Nomogram模型的预测效能。结果 观察组COPD病程和吸烟时间长于对照组,血清BNP水平、动脉血二氧化碳分压水平高于对照组,差异均有统计学意义（均P<0.05）。多因素logistic回归模型分析显示,COPD病程>10年、BNP>193.58 ng/mL、右心房横径（RA）>39.4 mm均是COPD合并肺心病的危险因素（均P<0.05）。Nomog ra m模型预测COPD合并肺心病的C指数为0.796(95%CI:0.514～0.973),当风险阈值>0.25时,此Nomogram模...     

血清糖类抗原125在慢性阻塞性肺疾病合并慢性肺源性心脏病的临床意义

目的:探讨血清糖类抗原125(CA125)在慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病患者血清中的表达水平及其临床意义。方法:将研究对象分为两组:COPD合并慢性肺源性心脏病组(294例),和单纯COPD组(234例)。收集所有研究对象的临床资料,进行超声心动图检查,并测定肿瘤标志物的血清学水平。结果:与单纯COPD组相比,COPD合并慢性肺源性心脏病组患者的血清CA125较单纯COPD组显著升高(P0.05);而其它肺瘤标志物(癌胚抗原、鳞状上皮细胞癌抗原、血清骨胶素和胃泌素释放肽前体)在两组之间比较,差异无统计学意义(P0.05)。结论:血清CA125可能被用于判断COPD是否合并慢性肺源性心脏病的一个血清学指标。     

慢性阻塞性肺疾病合并慢性肾脏病危险因素分析

目的探讨住院COPD患者合并慢性肾脏病的患病率及危险因素。方法对2012年1月至2013年11月住院确诊的COPD患者进行慢性肾脏病的患病率及危险因素回顾性凋查。结果在资料完整的948例COPD患者人群中,慢性肾脏病总的患病率约为24．5％,COPD合并慢性肾脏病组PaCO2、吸烟指数、血尿酸水平、糖尿病及高血压病患病率较无合并慢性肾脏病组高,而PaO2、体质量指数较无合并慢性肾脏病组低,差异有统计学意义。COPD患者合并慢性肾脏病与COPD严重程度分级无明显的相关性。经多因素Logistic回归分析表明：低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素（OR值分别为2．34、3．25、2．67和1．8,9,5％（71分别为2．01～2．75、2．95～3．77、1．99～3．27、1．18～2．63,P值均〈0．05）。结论COPD合并慢性肾脏病的患病率高,低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素,应引起重视。     

青海高原慢性阻塞性肺疾病所致慢性肺源性心脏病流行病学调查

目的 了解青海高原慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)所致慢性肺源性心脏病的患病情况.方法 采用分层、不等比、整群随机抽样方法对青海省≥15岁共计23 725人,按照"慢性阻塞性肺疾病,肺心病高危人群基线调查表"进行COPD流行病学调查.对肺功能检查筛...     

慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的危险因素分析

目的探讨慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌病(IPA)的危险因素。方法采用病例对照研究方法,选取2015-05～2018-05该院呼吸内科住院的COPD合并IPA的住院患者24例为病例组,以年龄为匹配因素(±2岁),按1∶2的比例选取同期住院的COPD患者48例为对照组,采用条件Logistic回归分析对COPD合并IPA的危险因素进行分析。结果单因素分析结果显示COPD频繁急性加重、糖尿病、慢性肾功能不全、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的危险因素(P0.10);采用条件Logistic分析,糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素(OR=7.384,6.681,32.354,P0.05)。结论糖尿病、应用广谱抗生素≥2周、应用糖皮质激素为COPD合并IPA的独立危险因素。     

慢性支气管炎、慢性肺源性心脏病急性加重住院患者死亡危险因素的分析

目的探讨慢性支气管炎、慢性肺源性心脏病急性加重住院患者死亡的危险因素。方法回顾性分析2008-2015年入住我科的1 460例慢性支气管炎、慢性肺源性心脏病急性加重住院患者的临床资料,应用SPSS 17软件对年龄、性别、肺气肿、肺大泡、肺炎、支气管扩张、哮喘、肺栓塞、恶性肿瘤、冠心病、高血压病、糖尿病、低蛋白血症、贫血、肝功能异常、肾功能异常等因素进行Logistic分析,并对该病种收治患者、死亡患者的时节进行分析。结果 1 460例患者中,正常出院患者1 393例,死亡患者67例。高龄、肺炎、恶性肿瘤、低蛋白血症、贫血、肝功能异常、肾功能异常是死亡的危险因素(OR1,P0.05);合并支气管扩张、支气管哮喘,并未增加病死率;季节变换时期及冬季该病种住院患者病死率明显高于其他时节。结论高龄、肺炎、恶性肿瘤及患者的营养状态、各脏器功能状态是慢性支气管炎、慢性肺源性心脏病急性加重住院患者死亡的危险因素,在临床工作中对这一类患者加强教育、积极控制合并症、加强营养等具有重要的意义,针对该病种患者,加强换季预防可能是减少其死亡的方法之一。     

COPD合并慢性肺源性心脏病与否的肺功能对比分析

目的 通过对单纯COPD与肺心病患者的肺功能进行对比分析,了解COPD合并肺心病与否时的肺功能改变.方法 对所有入选的COPD患者进行肺功能和心脏超声检查,COPD患者GOLD分级为Ⅱ～Ⅳ级.根据有无肺心病将入选患者分为单纯COPD组和COPD合并肺心病组.单纯COPD组37例;COPD合并肺心病组31例.结果 COPD合并肺心病组DLCO% pred显著低于单纯COPD组(P<0.05);两组间FEV1% pred、FVC% pred、FEV1/FVC、RV% pred、TLC% pred、RV/TLC和共振频率无显著差异(P＞0.05).结论 COPD合并肺心病患者较单纯COPD患者肺弥散功能的损害更为显著.     

慢性阻塞性肺疾病危险因素

慢性阻塞性肺疾病 (COPD)是环境、遗传及其相互作用共同参与的疾病过程。在环境因素方面除吸烟外还包括儿童时期呼吸道感染、潜伏的腺病毒感染和空气污染等。在遗传因素方面 ,有多种不同功能的候选基因可能参与发病 ;深入了解环境及遗传的各种环节有助于更好的防治该病。     

慢性肺源性心脏病53例分析

社会人口的逐渐老年化 ,慢性肺源性心脏病的患病率在逐年上升 ,已成为危害老年人身体健康的重要疾病之一 ,受到人们的广泛关注。本文就我院 1996- 2 0 0 0年收治的 5 3例慢性肺源性心脏病 (以下简称肺心病 )作一临床分析。1　临床资料1.1　一般资料　全组共 5 3例 ,男 3 9例 ,女 14例 ,年龄最大者83岁 ,最小者 3 0岁 ,平均年龄 68岁 ,均为急性期患者 ,符合1997年全国第二次肺心病专业会议的肺心病诊断标准。1.2　基础疾病　慢性支气管炎、阻塞性肺气肿 4 4例 ,合并阻塞性睡眠呼吸暂停综合征 3例 ,支气管哮喘 5例 ,先天性胸廓畸形 1例。1.3　…     

慢性阻塞性肺疾病合并肺血栓栓塞危险因素分析

目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺血栓栓塞(pulmonary thromboembolism,PTE)的临床特征以及相关危险因素。方法 选择2012年8月至2014年7月入住本院的362例COPD患者,根据肺动脉造影(computed tomographic pulmonary angiography,CTPA)结果将患者分为COPD合并PTE组与无PTE组,收集两组患者的一般资料、临床特征以及辅助检查,对其进行统计分析。结果 两组患者在卧床史(≥7 d)(32.05%vs.18.31%,P=0.009)、合并糖尿病病史(33.33%vs.20.42%,P=0.017)、双下肢不对称水肿(8.97%vs.3.52%,P=0.044)、晕厥(0.089%vs.3.17%,P=0.027)、静脉血栓(19.85%vs.8.45%,P=0.015)、白细胞(P=0.014)、血红蛋白(P=0.006)、D-二聚体(P<0.001)、Pa O2(P<0.001)、Pa CO2(P<0.001)、FEV1%(P<0.001)等方面有明显的统计学差异;而在其他一般情况、临床特征及辅助检查等方面无统计学差异(P>0.05)。结论卧床史(≥7 d)、静脉血栓形成、D-二聚体升高、低Pa O2、FEV1%下降可能是COPD合并PTE的危险因素。     

伊伐布雷定对慢性阻塞性肺疾病所致慢性肺源性心脏病失代偿期患者心肺功能的影响

目的:观察伊伐布雷定对COPD所致慢性肺源性心脏病失代偿期患者心肺功能的影响。方法：62例COPD所致慢性肺源性心脏病患者随机分为常规治疗组及伊伐布雷定组,进行常规抗心衰治疗或联合伊伐布雷定治疗3个月,记录治疗前后NT-proBNP、hs-CRP、PCT、肺功能、COPD评估测试(CAT)、6分钟步行实验距离、心脏彩超(LVEF、SV、RVD)、24小时平均心率等治疗。结果：两组患者治疗前一般情况一致,无统计学差异。治疗后,伊伐布雷定组患者6分钟步行实验距离、CAT评分均改善,NT-proBNP较常规治疗组明显降低,24小时平均心率明显下降,两组差异具有统计学意义。hs-CRP、PCT、肺功能指标(PEF、FEV1%pred、FEV1/FVC％)、LVEF、SV、RVD改变无统计学差异。结论:在COPD所致肺心病患者中应用伊伐布雷定3个月,可改善患者心功能,提高运动耐量及生活质量,但对患者肺功能及心脏改变无影响。     

Echocardiographic Detection of Occult Cor Pulmonale During Exercise in Patients with Chronic Obstructive Pulmonary Disease

We tested the ability of cycle ergometer exercise echocardiography to detect cases of occult cor pulmonale among 25 patients with chronic obstructive pulmonary disease (COPD). The M-mode echocardiographic ventricular septal motion, left ventricular shape determined by short-axis two-dimensional (2-D) echocardiography, and right and left ventricular pressure curves were recorded at rest and during exercise and were compared between patients. The ventricular septal motion was normal at rest in all of the patients. In nine patients (dip group), there was marked downward ventricular septal motion in early diastole during exercise, indicating distortion of the left ventricular shape. There were no distinct changes in the remaining 16 patients (non-dip group). At rest, the cardiac index was significantly lower, and right ventricular systolic and mean pulmonary artery pressures were significantly higher in the dip group than in the non-dip group. However, no significant difference was noted in the right ventricular end-diastolic pressure between the two groups at rest. The right ventricular systolic and end-diastolic pressures were greater during exercise in the dip group than in the non-dip group. In all of the patients in the dip group, the right ventricular pressure exceeded the left ventricular pressure only in early diastole, coinciding with the early diastolic dip of the ventricular septum, during exercise. In conclusion, occult cor pulmonale can be diagnosed accurately by the appearance of an early diastolic dip of the ventricular septum and distorted left ventricular shape during exercise in patients with COPD.     

老年慢性阻塞性肺疾病患者并发心房颤动的危险因素及其列线图模型构建

背景近年随着我国老龄化加重,慢性阻塞性肺疾病(COPD)合并心房颤动(AF)患者数量不断增加,继而带来更加沉重的医疗负担。因此,早期识别伴有AF高风险的老年COPD患者并积极干预具有重要意义。目的探讨老年COPD患者并发AF的危险因素,并构建列线图模型,以期能早期识别伴有AF高风险的老年COPD患者。方法选取2019年1月至2021年5月在扬州大学附属医院住院的老年COPD患者254例,根据患者是否并发AF分为AF组(n=39)和非AF组(n=215)。比较两组患者临床资料,老年COPD患者并发AF的影响因素分析采用多因素Logistic回归分析,采用R语言软件构建老年COPD患者并发AF的列线图模型;绘制受试者工作特征(ROC)曲线以评估该列线图模型对老年COPD患者并发AF的区分度,采用Hosmer-Lemeshow拟合优度检验验证该列线图模型对老年COPD患者并发AF的校准度。结果 AF组患者吸烟率、饮酒率及心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中、急性心肌梗死发生率高于非AF组(P <0.05)。多因素Logistic回归分析结果显示,心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中及急性心肌梗死是老年COPD并发AF的危险因素(P <0.05)。基于上述危险因素构建老年COPD患者并发AF的列线图模型。ROC曲线分析结果显示,该列线图模型预测老年COPD患者并发AF的曲线下面积(AUC)为0.809[95%CI(0.752,0.865)]。Hosmer-Lemeshow拟合优度检验结果显示,预测值与实际值比较,差异无统计学意义(P> 0.05)。结论心力衰竭、糖尿病、急性呼吸衰竭、肺部感染、脑卒中及急性心肌梗死是老年COPD患者并发AF的危险因素,而基于上述危险因素构建的列线图模型对老年COPD患者并发AF的区分度及校准度良好。     

Prevalence and Risk Factors for Depressive Symptoms in Persons with Chronic Obstructive Pulmonary Disease

Background  Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD). Objective  To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD. Design and Patients  Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged ≥50 years who participated in the 2004 Health and Retirement Survey. Measurements  Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score ≥3 on CES-D8 were classified as having clinically significant depressive symptoms. Main Results  Of 1,736 participants with COPD, 40% had ≥3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for ≥3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02–1.03]), female gender (1.2 [1.1–1.3]), current smoking (1.5 [1.3–1.7]), marital status [divorced/separated (1.8 [1.6–2.1]), widowed (1.8 [1.6–2]), never married (1.4 [1.1–1.8]), ≤high school degree (1.6 [1.5–1.8]), dyspnea (2.3 [2.1–2.6]), difficulty walking (2.8 [2.5–3.2]), and co-morbid diabetes (1.2 [1.1–1.4]), arthritis (1.3 [1.2–1.5]) or cancer (1.2 [1.1–1.4]). Conclusions  Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients. An erratum to this article can be found at     

Risk Factors for Respiratory Syncytial Virus Illness Among Patients with Chronic Obstructive Pulmonary Disease

Abstract

Respiratory syncytial virus (RSV), although not typically considered an important pathogen in adults, may cause acute exacerbation of chronic obstructive pulmonary disease (COPD). It is unclear which COPD patients are at highest risk for developing serious RSV illness. Our objective was to identify risk factors for RSV illness among adult patients with COPD. We conducted a pooled analysis of data from COPD patients in 2 previously published longitudinal studies that examined RSV infection in high risk adults for ≤ 2 RSV seasons. Risk factors for RSV illness studied included age, sex, race, smoking status, exposure to children, home oxygen use, inhaled or oral steroid use, instrumental activities of daily living scores, and co-morbid conditions. Outcomes studied included symptomatic and medically attended RSV illness. Logistic regression was used to identify significant risk factors for RSV illness among older adults with COPD. Among 379 patients with COPD, the rate of symptomatic RSV illness was 11.1% (42/379); almost half (20/42) of whom required medical attention. In multivariable analyses, congestive heart failure (odds ratio [OR] = 4.18; 95% CI: 1.38, 12.69) and exposure to children (OR = 2.38; 95% CI: 1.03, 5.51) were risk factors for symptomatic RSV illness. Congestive heart failure (OR = 4.16; 95% CI: 1.02, 17.01) was the only significant risk factor for developing medically attended RSV illness. Exposure to children and congestive heart failure are risk factors for RSV illness among adult patients with COPD. Future prospective, well-designed studies are needed to corroborate these findings and examine other risk factors, including history of exacerbations.     

Prevalence of Physical Disability in Patients with Chronic Obstructive Pulmonary Disease and Associated Risk Factors

Abstract

Introduction: To analyze the prevalence of disability among patients with COPD as compared to people without this lung disease and to identify sociodemographic and health factors associated with these physical limitations. Methods: We performed a cross-sectional study based on data taken from the European Health Interview Survey for Spain (EHISS) 2009. The survey included adults aged 40 to 79 years (n = 13624). We identified patients with COPD using a direct question from the survey. The main study variable was disability, including basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility disability (MD). Independent variables analyzed included socio-demographic characteristics, self-perceived health status, presence of mental disease and co-morbid chronic conditions and lifestyles. Results: The overall prevalence of self-reported COPD was 7.2%. The total prevalence of ADL, IADL and MD was higher among men suffering COPD than among the population without this disease (16.39% vs. 4.91%; 27.70% vs. 12.45%; 48.94% vs. 17.46% respectively). These significant differences were also observed among women with equivalent figures of: 23.25% vs. 8.71%; 31.03% vs. 10.53%; 64.83% vs. 34.08%. Being older, having a self-perceived health status of “fair/poor/very poor” and suffering from mental disease (anxiety and/or depression) were factors associated with a higher probability of reporting any disability in both men and women suffering from COPD. Conclusions: Higher rates of disability were seen among COPD patients compared to the general population. Among COPD patients older age, depression, anxiety and worse self-rated health were associated with higher disability.     

慢性肺心病QRS向量系统性研究

为探索心电向量图对慢性肺心病右室肥大的诊断标准,对50例肺心病、32例肺气肿和143例,正常成人的QRS向量进行了系统性研究。结果表明,取Rx<0.5mV、Sx/Rx>0.58、横面S/R>1.1、最大空间向量仰角≥65°为右室肥大诊断标准,对肺心病诊断敏感性为90％,对肺气肿及正常组诊断特异性分别为87.5％和96.5％。