Ishifuji Tomoko, Sando Eiichiro, Kaneko Norihiro, Suzuki Motoi, Kilgore Paul E, Ariyoshi Koya, Morimoto Konosuke, Hosokawa Naoto, Yaegashi Makito, Aoshima Masahiro
Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki, 852-8523, Japan.
Department of Clinical Tropical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
BMC Pulm Med. 2017 Jan 11;17(1):12. doi: 10.1186/s12890-016-0359-1.
In Japan and other societies with rapidly aging populations, recurrent pneumonia (RP) is a major clinical problem yet only limited information exists regarding the burden of this disease.
A prospective study of adult pneumonia was conducted to investigate the incidence of RP and potential risk factors. From February 1, 2012 to January 31, 2013, patients aged ≥ 15 years who were diagnosed with pneumonia were prospectively enrolled in a representative community hospital located in central Japan. Patients were followed for one-year to evaluate the recurrence of pneumonia and characteristics associated with RP. Cox proportional hazards models were constructed to compute adjusted hazard ratios (aHR) and ascertain risk factors significantly associated with RP.
In total, 841 patients with a median age of 73 years (range 15-101 years) were enrolled totaling 1,048 person-years of observation with a median follow-up time of 475 days. A total of 137 patients had at least one recurrent episode with an incidence rate of 13.1 per 100 person-years (95% confidence interval: 11.1-15.5). In multivariate analysis, a past history of pneumonia (aHR 1.95, 95% CI: 1.35-2.8), chronic pulmonary disease (aHR 1.86, 1.24-2.78) and inhaled corticosteroid usage (aHR 1.78, 1.12-2.84) and hypnotic/sedative medication usage (aHR 2.06, 1.28-3.31) were identified as independent risk factors for recurrent pneumonia, whereas angiotensin converting enzyme-inhibitors usage was associated with a reduction of the risk of RP (aHR 0.22, 0.05-0.91). The detection of P. aeruginosa was significantly associated with RP even after adjusting for chronic pulmonary diseases (aHR = 2.37).
Recurrent pneumonia constitutes a considerable proportion of the pneumonia burden in Japan. A past history of pneumonia, chronic pulmonary disease, inhaled corticosteroid and hypnotic/sedative medication usage and detection of P. aeruginosa were identified as independent risk factors for recurrent pneumonia and special attention regarding the use of medications in this vulnerable population is needed to reduce the impact of this disease in aging populations.
在日本及其他人口快速老龄化的社会中，复发性肺炎（RP）是一个主要的临床问题，但关于这种疾病负担的信息有限。
开展一项针对成人肺炎的前瞻性研究，以调查复发性肺炎的发病率及潜在风险因素。2012年2月1日至2013年1月31日，年龄≥15岁且被诊断为肺炎的患者被前瞻性纳入位于日本中部的一家代表性社区医院。对患者进行为期一年的随访，以评估肺炎复发情况及与复发性肺炎相关的特征。构建Cox比例风险模型以计算调整后的风险比（aHR），并确定与复发性肺炎显著相关的风险因素。
共纳入841例患者，中位年龄为73岁（范围15 - 101岁），总计1048人年的观察期，中位随访时间为475天。共有137例患者至少有一次复发，发病率为每100人年13.1例（95%置信区间：11.1 - 15.5）。在多变量分析中，肺炎病史（aHR 1.95，95% CI：1.35 - 2.8）、慢性肺病（aHR 1.86，1.24 - 2.78）、吸入性糖皮质激素使用（aHR 1.78，1.12 - 2.84）和催眠/镇静药物使用（aHR 2.06，1.28 - 3.31）被确定为复发性肺炎的独立风险因素，而使用血管紧张素转换酶抑制剂与复发性肺炎风险降低相关（aHR 0.22，0.05 - 0.91）。即使在对慢性肺病进行调整后，铜绿假单胞菌的检测仍与复发性肺炎显著相关（aHR = 2.37）。
在日本，复发性肺炎在肺炎负担中占相当大的比例。肺炎病史、慢性肺病、吸入性糖皮质激素和催眠/镇静药物使用以及铜绿假单胞菌的检测被确定为复发性肺炎的独立风险因素，需要特别关注在这一脆弱人群中的用药情况，以减少这种疾病对老龄化人群的影响。
