目的 探讨老年慢性阻塞性肺疾病(COPD)患者急性加重的影响因素。方法 回顾性选择2017-01至2024-12在武警北京总队医院治疗的102例老年慢性阻塞性肺疾病急性加重期(AECOPD)患者为AECOPD组;选择同期慢性阻塞性肺疾病(COPD)患者未出现急性加重的100例为COPD稳定组,比较两组中一般资料与血液常规检验指标、感染指标[血清降钙素原(PCT)、白介素-6(IL-6)、肿瘤坏死因子(TNF)-α、超敏C反应蛋白(hs-CRP)、白细胞计数、淋巴细胞计数、中性粒细胞/淋巴细胞比值(NLR)、嗜酸粒细胞计数(EOS)]、血生化指标[空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)、尿酸(UA)]、D-二聚体(D-D)、心力衰竭指标血清氨基末端B型脑钠肽前体(NT-proBNP)、血气分析指标[pH值、乳酸(Lac)],采用多因素二元logistic回归分析探讨与AECOPD发生的相关因素。结果 AECOPD组患者社区获得性肺炎占比、NT-proBNP、hs-CRP、TNF-α、D-D、NLR、EOS、Lac、PCT、IL-6高于COPD稳定组(P＜0.05)。多因素logistic回归分析结果提示,NT-proBNP、hs-CRP、TNF-α、D-D与AECOPD发生相关(P＜0.05),hs-CRP、TNF-α是AECOPD发生的独立影响因素(P＜0.05)。结论 AECOPD 患者的社区获得性肺炎占比、NT-proBNP、hs-CRP、TNF-α、D-D、NLR、EOS、Lac、PCT、IL-6高,且NT-proBNP、hs-CRP、TNF-α、D-二聚体与AECOPD发生独立相关,为防治COPD进展、改善预后提供参考依据。
Abstract
Objective To explore the influencing factors of acute exacerbation in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A total of 102 elderly patients with acute exacerbation of COPD (AECOPD) treated at Beijing Municipal Corps Hospital of Chinese People’s Armed Police Force from January 2017 to December 2024 were retrospectively selected as the AECOPD group. Meanwhile, 100 patients without AECOPD were randomly selected as the COPD stable group. General data, blood routine test indicators, infection indicators [serum procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), white blood cell count, lymphocyte count, neutrophil/lymphocyte ratio (NLR), eosinophil count (EOS) levels], blood biochemical indicators [fasting blood glucose (FPG), HDL-C, LDL-C, TG, TC, Lac)] D-dimer (D-D), heart failure indicator serum N-terminal pro brain natriuretic peptide (NT proBNP), and blood gas analysis indicators (pH value, Lac) were compared between the two groups., and multivariate binary logistic regression analysis were used to explore the related factors of AECOPD occurrence. Results The proportion of community-acquired pneumonia, NT proBNP, hs-CRP, TNF-α, D-D, NLR, EOS, Lac, PCT, and IL-6 in the AECOPD group were higher than those in the COPD stable group (P＜0.05). The results of multivariate logistic regression analysis indicated that NT proBNP, hs-CRP, TNF-α, D-D were associated with the occurrence of AECOPD (P＜0.05), and hs CRP and TNF-α were independent influencing factors of AECOPD (P＜0.05). Conclusions The proportion of community-acquired pneumonia, NT proBNP, hs-CRP, TNF-α, D-dimer, NLR, EOS, Lac, PCT, IL-6 in AECOPD patients are significantly elevated, and NT proBNP, hs-CRP, TN-α and D-D are independently correlated with the occurrence of AECOPD, providing a reference basis for the prevention and treatment of COPD progression and improvement of prognosis.
关键词
慢性阻塞性肺疾病 /
急性加重期 /
超敏C反应蛋白 /
肿瘤坏死因子-α /
D-二聚体 /
氨基末端B型脑钠肽前体
Key words
chronic obstructive pulmonary disease /
acute exacerbation period /
hypersensitive c-reactive protein /
tumor necrosis factor-α /
D-dimer /
N-terminal B-type brain natriuretic peptide precursor
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Yang I A, Jenkins C R, Salvi S S. Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment[J]. Lancet Respir Med, 2022, 10(5):497-511.
[2] Liu X, Jiao X, Gong X, et al. Prevalence, Risk factor and clinical characteristics of venous thrombus embolism in patients with acute exacerbation of COPD: a prospective multicenter study[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18:907-917.
[3] Hu XJ, Xu J, Li P, et al. Correlation of serum Clara cell secretory protein 16, plasma fibrinogen and serum amyloid A with the severity of acute exacerbated COPD and their combination in prognosis assessment[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18:1949-1957.
[4] Qian Y, Cai C, Sun M, et al. Analyses of factors associated with acute exacerbations of chronic obstructive pulmonary disease: a review[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18:2707-2723.
[5] Ruan H, Zhang H, Wang J, et al. Readmission rate for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis[J]. Respir Med, 2023, 206:107090.
[6] Prediletto I, Giancotti G, Nava S. COPD exacerbation: why it is important to avoid ICU admission[J]. J Clin Med, 2023, 12(10):3369.
[7] Medrinal C, Bonnevie T. La kinésithérapie en per-et post-exacerbation immédiate de BPCO[Physiotherapy during and after acute exacerbation of COPD] [J]. Rev Mal Respi, 2022, 39(4):386-397.
[8] Pázmány P, Soós A, Hegyi P, et al. Inflammatory Biomarkers are inaccurate indicators of bacterial infection on admission in patients with acute exacerbation of chronic obstructive pulmonary disease-a systematic review and diagnostic accuracy network meta-analysis[J]. Front Med (Lausanne), 2021, 8:639794.
[9] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组, 中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3):170-205.
[10] Jiang Y, Li M, Yu Y, et al. Correlation between vitamin d, inflammatory markers, and t lymphocytes with the severity of chronic obstructive pulmonary disease and its effect on the risk of acute exacerbation: a single cross-sectional study[J]. Clin Ther, 2025, 47(1):44-54.
[11] Vogelmeier C F, Criner G J, Martinez F J. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 Report[J]. Am J Respir Crit Care Med, 2017, 195: 557-582
[12] Wang H, Yang T, Yu X, et al. Risk factors for length of hospital stay in acute exacerbation chronic obstructive pulmonary disease: a multicenter cross-sectional study[J]. Int J Gen Med, 2022, 15:3447-3458.
[13] Feng Y, Liu E. Detection of respiratory viruses and expression of inflammatory cytokines in patients with acute exacerbation chronic obstructive pulmonary disease in Mongolia China[J]. Braz J Biol, 2021, 82:e231134.
[14] Su B, Liu T, Fan H. Inflammatory markers and the risk of chronic obstructive pulmonary disease: A systematic review and meta-analysis[J]. PLoS One, 2016, 11: e150586.
[15] Ye C, Yuan L, Wu K, et al. Association between systemic immune-inflammation index and chronic obstructive pulmonary disease: a population-based study[J]. BMC Pulm Med, 2023, 23(1):295.
[16] Zhao X, Wu Y. Correlations of silent information regulator of transcription 1 (SIRT1) expression, inflammatory factors, and oxidative stress with pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)[J]. Med Sci Monit, 2021, 27:e929046.
[17] Guo P, Li R, Piao T H, et al. Pathological mechanism and targeted drugs of COPD[J]. Int J Chron Obstruct Pulmon Dis, 2021, 17:1565-1575.
[18] 万秋风, 郭志金, 才开·莎热丽, 等. 慢性阻塞性肺疾病急性加重患者血清成纤维细胞生长因子 7 及相关炎性因子的表达[J]. 中华危重病急救医学, 2021, 33(4):421-426.
[19] Bang D N, Thang T B, Van Mao C, et al. Evaluating the plasma interleukin-1 beta and interleukin-8 levels in patients with chronic obstructive pulmonary diseases following treatment with allogeneic mesenchymal stem cell derived from umbilical cord tissues and platelet rich plasma[J]. Vietnam J Biotechnol, 2023, 21(1): 1-13.
[20] Brusselle G, Pavord I D, Landis S, et al. Blood eosinophil levels as a biomarker in COPD[J]. Respir Med, 2018, 138:21-31.
[21] Lv M Y, Qiang L X, Li Z H, et al. The lower the eosinophils, the stronger the inflammatory response? The relationship of different levels of eosinophils with the degree of inflammation in acute exacerbation chronic obstructive pulmonary disease (AECOPD)[J]. J Thorac Dis, 2021, 13(1):232-243.
[22] Neunhäuserer D, Reich B, Mayr B, et al. Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD[J]. Scand J Med Sci Sports, 2021, 31(3):710-719.
[23] Sun W, Cao Z, Ma Y, et al. Fibrinogen, a Promising marker to evaluate severity and prognosis of acute exacerbation of chronic obstructive pulmonary disease: a retrospective observational study[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17:1299-1310.
[24] Li L, Feng Q, Yang C. The D-Dimer to albumin ratio could predict hospital readmission within one year in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2024, 19:2587-2597.
[25] Wada H, Ai I, Maruyma K, et al. Low BMI and weight loss aggravate COPD mortality in men, finding from large prospective cohort:the JACC study[J]. Scientific Reports, 2021, 11(1):58-62.
[26] Bel Haj Ali K, Sekma A, Chamtouri I, et al. Pulse amplitude ratio under noninvasive ventilation as a new method in the diagnosis of left heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease[J]. BMC Cardiovasc Disord, 2023, 23(1):105.
[27] Kitajima T, Marumo S, Amimoto H, et al. Relationship between episodic nocturnal hypercapnia and history of exacerbations in patients with advanced chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2022, 17:1553-1563.
PDF(986 KB)
