肺气肿和肺功能对慢性阻塞性肺疾病患者肺炎发生的影响
Implications of Emphysema and Lung Function for the Development of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease.
作者信息
Hong Yoonki, Lee Jae Seung, Yoo Kwang Ha, Lee Ji-Hyun, Kim Woo Jin, Lim Seong Yong, Rhee Chin Kook, Lee Sang-Do, Oh Yeon-Mok
机构信息
Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.
Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Tuberc Respir Dis (Seoul). 2016 Apr;79(2):91-7. doi: 10.4046/trd.2016.79.2.91. Epub 2016 Mar 31.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is sometimes complicated with pneumonia, but little is known about the risk factors that promote the development of pneumonia in COPD. These risk factors were evaluated in the present study.
METHODS
The data of 324 patients with COPD from a prospective multi-center observational cohort with obstructive lung disease were evaluated retrospectively. To identify risk factors for the development of pneumonia in COPD, the clinical and radiological data at enrollment and the time to the first episode of pneumonia were analyzed by Cox proportional hazard analysis.
RESULTS
The median follow-up time was 1,099 days and 28 patients (8.6%) developed pneumonia. The Cox analysis showed that post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted) and the computed tomography (CT) emphysema extent (inspiratory V950) were independent risk factors for the development of pneumonia (post-bronchodilator FEV1: hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.94-1.00; p=0.048 and inspiratory V950: HR, 1.04; 95% CI, 1.01-1.07; p=0.01).
CONCLUSION
Emphysema severity measured by CT and post-bronchodilator FEV1 are important risk factors for the development of pneumonia in COPD.
背景
慢性阻塞性肺疾病（COPD）有时会并发肺炎，但对于促进COPD患者发生肺炎的危险因素知之甚少。本研究对这些危险因素进行了评估。
方法
回顾性评估了来自一项前瞻性多中心阻塞性肺疾病观察队列的324例COPD患者的数据。为了确定COPD患者发生肺炎的危险因素，通过Cox比例风险分析对入组时的临床和影像学数据以及首次发生肺炎的时间进行了分析。
结果
中位随访时间为1099天，28例患者（8.6%）发生了肺炎。Cox分析显示，支气管扩张剂后一秒用力呼气容积（FEV1，预测值的百分比）和计算机断层扫描（CT）肺气肿程度（吸气V950）是发生肺炎的独立危险因素（支气管扩张剂后FEV1：风险比[HR]，0.97；95%置信区间[CI]，0.94-1.00；p=0.048；吸气V950：HR，1.04；95%CI，1.01-1.07；p=0.01）。
结论
通过CT测量的肺气肿严重程度和支气管扩张剂后FEV1是COPD患者发生肺炎的重要危险因素。
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