AECOPD与COPD合并CAP的差异队列研究

目的分析慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）与慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）合并社区获得性肺炎（communityacquired pneumonia,CAP）之间的差异。方法收集COPD患者共215例,根据病史及肺部CT分为AECOPD组（109例）及COPD合并CAP组（106例）。比较两组年龄、入院时体温、黄脓痰、住院天数及白细胞、血红蛋白、白蛋白、降钙素原、C反应蛋白、内毒素、白介素6、纤维蛋白原、肺功能之间的差异。结果 AECOPD组平均年龄、伴发热症状比例、黄脓痰比例、平均住院天数、白细胞、PCT、CRP、内毒素、IL-6及纤维蛋白原水平低于COPD合并CAP组,FEV1%（FEV1占预计值百分比）、平均血红蛋白、平均血清白蛋白高于COPD合并CAP组,差异均有统计学意义（P〈0.05）。年龄、PCT、纤维蛋白原、CRP、内毒素、白细胞与住院天数呈显著正相关（P〈0.05）,而血清白蛋白、血红蛋白、FEV1/FEV1预计值与住院天数呈显著负相关（P〈0.05）。结论 COPD合并CAP组营养状况及基础肺功能差,症状重,炎性标记物水平高,住院天数长。

Differences between acute exacerbation and complicated community acquired pneumonia in patients with chronic obstructive pulmonary disease

Objective To investigate the differences between acute exacerbation （AE） and complicated community-acquired pneumonia （CAP） in patients with chronic obstructive pulmonary disease （COPD） . Methods Two hundred and fifteen COPD patients were included in the study, including 109 cases of acute exacerbation COPD （AECOPD） and 106 cases complicated with CAP. The demographics, symptoms, white blood cell count, hemoglobin, albumin and inflammatory markers and length of hospital stay were retrospectively analyzed. Results Mean age of AECOPD group was significantly lower than COPD with CAP group （74.2 ± 11.3 vs 79.0 ± 8.1 y, P 〈 0. 001 ）. Eight patients （7.3%） in AECOPD group had fever, while 58 in COPD with CAP group （54.7%） ;37 patients （ 33.9% ） in AECOPD group had yellow purulent sputum, which were significantly lower than COPD with CAP group （86/106, 81.3% ）. The length of hospital stay in COPD with CAP group were significantly longer than that in AECOPD group （ 15.8 ± 5.0 vs 12.6 ± 3.3 d, P 〈 0. 001 ）. Values of FEV1/FEV1 predicted （49.5 ± 11.4% vs 38. 1 ± 6.5%, P = 0.0006）, hemoglobin （136.9 ±15.4 g/L vs 126.4 ±21.0 g/L, P 〈0.001） and serum albumin（37.1 ±3.8 g/L vs 32.9 ± 4.2 g/L, P = 0.000 2 ） in AECOPD group were significantly higher than those in COPD with CAP group. Levels of WBC, PCT, CRP, endotoxin, IL-6 and fibrinogen in COPD with CAP group were significantly higher than those in AECOPD group （ P 〈 0. 05 ）. The length of hospital stay was positively correlated with age, PCT, fibrinogen, CRP, endotoxin levels and WBC count, and negatively correlated with serum albumin, hemoglobin levels and FEV1/FEV1 predicted. Conclusion COPD patients with CAP are prone to have poor nutritional status, poor lung function, serious symptoms, high levels of inflammatory markers and longer hospitalization days.