慢性高碳酸血症型慢性阻塞性肺疾病患者的生存率可通过吸烟习惯、合并症和低氧血症来预测。

Survival of chronic hypercapnic COPD patients is predicted by smoking habits, comorbidity, and hypoxemia.

作者信息

Nizet Tessa A C, van den Elshout Frank J J, Heijdra Yvonne F, van de Ven Marjo J T, Mulder Paul G H, Folgering Hans Th M

机构信息

Department of Pulmonary Diseases, Rijnstate Hospital Arnhem, PO Box 9555, 6800 TA Arnhem, Netherlands.

出版信息

Chest. 2005 Jun;127(6):1904-10. doi: 10.1378/chest.127.6.1904.

DOI:10.1378/chest.127.6.1904

PMID:15947301

Abstract

STUDY OBJECTIVES

Chronic hypercapnia in patients with COPD has been associated with a poor prognosis. We hypothesized that, within this group of chronic hypercapnic COPD patients, factors that could mediate this hypercapnia, such as decreased maximum inspiratory mouth pressure (P(I(max))), decreased maximum expiratory mouth pressure (P(E(max))), and low hypercapnic ventilatory response (HCVR), could be related to survival. Other parameters, such as arterial blood gas values, airway obstruction (FEV1), body mass index (BMI), current smoking status, and the presence of comorbidity were studied as well.

METHODS

A cohort of 47 chronic hypercapnic COPD patients recruited for short-term trials (1 to 3 weeks) in our institute was followed up for 3.8 years on average. Survival was analyzed using a Cox proportional hazards model. The risk factors considered were analyzed, optimally adjusted for age and gender.

RESULTS

At the time of analysis 18 patients (10 male) were deceased. After adjusting for age and gender, P(I(max)), P(E(max)), and HCVR were not correlated with survival within this hypercapnic group. Current smoking (hazard ratio [HR], 7.0; 95% confidence interval [CI], 1.4 to 35.3) and the presence of comorbidity (HR, 5.5; 95% CI, 1.7 to 18.7) were associated with increased mortality. A higher Pa(O2) affected survival positively (HR, 0.6 per 5 mm Hg; 95% CI, 0.4 to 1.0). Pa(CO2) tended to be lower in survivors, but this did not reach statistical significance (HR, 2.0 per 5 mm Hg; 95% CI, 0.9 to 4.3). FEV1 and BMI were not significantly related with survival in hypercapnic COPD patients.

CONCLUSION

In patients with chronic hypercapnia, only smoking status, the presence of comorbidity, and Pa(O2) level are significantly associated with survival. Airway obstruction, age, and BMI are known to be predictors of survival in COPD patients in general. However, these parameters do not seem to significantly affect survival once chronic hypercapnia has developed.

摘要

研究目的

慢性阻塞性肺疾病（COPD）患者的慢性高碳酸血症与预后不良相关。我们假设，在这群慢性高碳酸血症COPD患者中，可能介导这种高碳酸血症的因素，如最大吸气压（P(I(max))）降低、最大呼气压（P(E(max))）降低和低碳酸通气反应（HCVR），可能与生存率有关。还研究了其他参数，如动脉血气值、气道阻塞（FEV1）、体重指数（BMI）、当前吸烟状况和合并症的存在情况。

方法

在我们研究所招募的47例慢性高碳酸血症COPD患者组成的队列，进行了为期1至3周的短期试验，并平均随访3.8年。使用Cox比例风险模型分析生存率。对所考虑的危险因素进行分析，并根据年龄和性别进行最佳调整。

结果

在分析时，18例患者（10例男性）死亡。在调整年龄和性别后，P(I(max))、P(E(max))和HCVR与该高碳酸血症组的生存率无关。当前吸烟（风险比[HR]，7.0；95%置信区间[CI]，1.4至35.3）和合并症的存在（HR，5.5；95%CI，1.7至18.7）与死亡率增加相关。较高的动脉血氧分压（Pa(O2)）对生存率有积极影响（HR，每5mmHg为0.6；95%CI，0.4至1.0）。幸存者的动脉血二氧化碳分压（Pa(CO2)）往往较低，但这未达到统计学显著性（HR，每5mmHg为2.0；95%CI，0.9至4.3）。FEV1和BMI与高碳酸血症COPD患者的生存率无显著相关性。