COPD病人共患疾病的种类在COPD稳定期病人中的预后价值

目的探讨慢性阻塞性肺疾病（COPD）病人共患疾病的种类在COPD稳定期病人中的预后价值。方法回顾性分析52例COPD稳定期病人临床资料，分析共患疾病情况与Charlson合并症指数（CCI），按照CCI评分分为高分组（25例）与低分组（26例），按共患疾病数分为较少共患疾病组（24例）与较多共患疾病组（27例），比较各组临床表现，观察共患疾病数量、种类与病人肺功能关系。结果与低分组比较，高分组病人年龄大、FEV1占预计值百分比低，且伴大量COPD相关共患疾病，在1年随访期间病人住院次数多（P < 0.05~P < 0.01）；与较少共患疾病组比较，较多共患疾病组病人年龄大、mMRC评分高、FEV1占预计值百分比低、CCI评分与年龄校正后CCI评分高，随访过程中因COPD急性加重病人采用全身糖皮质激素与抗生素的疗程增加（P < 0.05~P < 0.01）；较少共患疾病组与较多共患疾病组随访期间急性加重总次数差异无统计学意义（P>0.05）；伴支气管扩张COPD病人在随访期间住院次数、急性加重总次数均高于无支气管扩张病人（P < 0.05）；但COPD加重造成门诊与社区就诊、急诊次数差异无统计学意义（P>0.05）。结论COPD病人共患疾病类型、评估共患疾病程度对COPD病人全方面诊断与预后价值具有相关性。

The prognostic value of comorbidities disease in patients with stable COPD

ObjectiveTo investigate the prognostic value of comorbidities in patients with stable chronic obstructive pulmonary disease(COPD).MethodsThe clinical data of 51 stable COPD patients were retrospectively analyzed, and the Charlson comorbidity index(CCI) was calculated.According to the CCI, patients were divided into high score group(n=25) and low score group(n=26).The patients were divided into the less co-morbidity group(n=24) and more co-morbidity group(n=27) according to co-morbidity numbers.The clinical characteristics, and correlation of number and type of comorbidities with pulmonary function were compared between two groups.ResultsCompared with the low score group, the age was older, the ratio of FEV1 accounting for expected value was lower, the number of COPD related comorbidities was larger, and the number of hospitalizations was more during 1 year following-up in high score group(P < 0.05 to P < 0.01).Compared with the less co-morbidity group, the age was older, the mMRC score was higher, the ratio of FEV1 accounting for expected value was lower, the CCI score and CCI score after adjusting age were higher, and the treatment course with systemic glucocorticoids and antibiotics because of the COPD acute exacerbating increased during the following-up in more co-morbidity group(P < 0.05 to P < 0.01).There was no statistical significance in the total number of acute exacerbation patients between less co-morbidity group and more co-morbidity group during the following-up(P>0.05).The number of hospital stays and total number of acute exacerbations in patients with COPD complicated with bronchiectasis were higher than those in patients without bronchiectasis(P < 0.05).However, there was no statistically significance among the number of outpatient and community visits, and emergency visits due to exacerbation of COPD(P>0.05).ConclusionsThe type and disease degree of comorbidities are correlation with the diagnosis and prognosis value in COPD patients.