职业性疾病预防机构中尘肺病患者 COPD 的患病率和特征：一项横断面研究。
Prevalence and characteristics of COPD among pneumoconiosis patients at an occupational disease prevention institute: a cross-sectional study.
机构信息
Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, 410011, China.
出版信息
BMC Pulm Med. 2018 Jan 29;18(1):22. doi: 10.1186/s12890-018-0581-0.
BACKGROUND
Pneumoconiosis may play an important role in the development of chronic obstructive pulmonary disease (COPD), and the complication of COPD may impose a heavy burden of illness.
METHODS
The study was conducted in Hunan Province in China from December 1, 2015, to December 1, 2016. Consecutive underground male pneumoconiosis patients employed for at least 1 year were recruited from the Hunan Occupational Disease Prevention Institute. Patient information, respiratory symptoms and clinical data were collected using a structured questionnaire. The diagnosis of COPD were assessed using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Logistic regression analyses were conducted to examine the clinical and demographic risk factors of COPD among pneumoconiosis patients.
RESULTS
The prevalence of COPD in our sample of pneumoconiosis patients was 18.65% (119/638). In pneumoconiosis patients with and without smoking history, the prevalence of COPD was 19.32 and 16.77%. Compared with non-COPD patients, those with COPD are older in age, have longer exposure time, have lower body mass index (BMI), have a higher smoking index and have worse pulmonary function (all p < 0.05). For the five respiratory symptoms (cough, sputum, wheeze, dyspnea, and chest tightness), only the presence of wheeze and the severity scores for wheeze or dyspnea showed significant differences between the COPD and non-COPD groups (p < 0.01). Multivariate logistic regression analysis revealed that advanced pneumoconiosis category, older age and the presence of wheeze symptoms were significant risk factors for the development of COPD among pneumoconiosis patients.
CONCLUSION
Pneumoconiosis patients are at a high risk of COPD, and pneumoconiosis patients with COPD may suffer more severe respiratory symptoms, such as wheeze and dyspnea, than patients without COPD. Advanced pneumoconiosis category, older age and the presence of wheeze symptoms are associated with an increased risk of COPD in pneumoconiosis. We proposed that a routine assessment of lung function is necessary for timely and adequate clinical management.
背景
尘肺病可能在慢性阻塞性肺疾病（COPD）的发展中起重要作用，COPD 的并发症可能会带来沉重的疾病负担。
方法
本研究于 2015 年 12 月 1 日至 2016 年 12 月 1 日在中国湖南省进行。连续招募了在湖南省职业病防治院工作至少 1 年的井下男性尘肺病患者。使用结构化问卷收集患者信息、呼吸症状和临床数据。采用全球慢性阻塞性肺疾病倡议（GOLD）标准评估 COPD 诊断。采用 logistic 回归分析探讨尘肺病患者 COPD 的临床和人口统计学危险因素。
结果
在我们的尘肺病患者样本中，COPD 的患病率为 18.65%（119/638）。在有和无吸烟史的尘肺病患者中，COPD 的患病率分别为 19.32%和 16.77%。与非 COPD 患者相比，COPD 患者年龄更大，暴露时间更长，体重指数（BMI）更低，吸烟指数更高，肺功能更差（均 P<0.05）。对于咳嗽、咳痰、喘息、呼吸困难和胸闷五种呼吸症状，仅喘息的存在和喘息或呼吸困难的严重程度评分在 COPD 和非 COPD 组之间存在显著差异（P<0.01）。多因素 logistic 回归分析显示，严重的尘肺病类别、年龄较大和存在喘息症状是尘肺病患者发生 COPD 的显著危险因素。
结论
尘肺病患者患 COPD 的风险较高，且患有 COPD 的尘肺病患者可能比没有 COPD 的患者有更严重的呼吸症状，如喘息和呼吸困难。严重的尘肺病类别、年龄较大和存在喘息症状与尘肺病患者发生 COPD 的风险增加相关。我们建议对肺功能进行常规评估，以进行及时和充分的临床管理。
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