支气管扩张-COPD 重叠综合征患者的急性呼吸道事件：一项基于人群的队列研究。
Acute respiratory events in patients with bronchiectasis-COPD overlap syndrome: A population-based cohort study.
机构信息
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
出版信息
Respir Med. 2018 Jul;140:6-10. doi: 10.1016/j.rmed.2018.05.008. Epub 2018 May 16.
BACKGROUND
The clinical phenotypes of chronic obstructive pulmonary disease (COPD) are related to various outcomes. We investigated the risk of acute respiratory events in patients with bronchiectasis-COPD overlap syndrome (BCOS) in Taiwan.
METHODS
We included 3955 patients who received diagnoses of COPD and bronchiectasis from 2000 to 2007 from the Taiwan Longitudinal Health Insurance Database in the BCOS cohort. In the comparison cohort, we included patients with COPD but without bronchiectasis at a ratio of 4:1, frequency matched by age, sex, and index year with each patient with BCOS. We followed both cohorts for 5 years to investigate the incidence and risk of acute respiratory events in the BCOS cohort relative to the comparison cohort, the incidence rate ratios (IRRs) and corresponding 95% confidence intervals (CIs) were determined using Poisson regression models.
RESULTS
The BCOS cohort experienced more episodes of acute respiratory events than did the comparison cohort (16.4 vs 5.52 per 100 person-y). After adjustment for potential covariates, the BCOS cohort had a 2.20-fold higher risk of pneumonia (adjusted IRR = 2.20, 95% CI = 2.06-2.34), a 3.88-fold higher risk of acute exacerbation (adjusted IRR = 3.88,95% CI = 3.64-4.13), a 1.74-fold higher risk of acute respiratory failure (adjusted IRR = 1.74,95% CI = 1.47-2.06), and a 1.99-fold higher risk of cardiopulmonary arrest (adjusted IRR = 1.99,95% CI = 1.81-2.20) than did the comparison cohort.
CONCLUSION
The patients with BCOS had a higher risk of acute respiratory events than did COPD patients without bronchiectasis.
背景
慢性阻塞性肺疾病（COPD）的临床表型与各种结局相关。我们在台湾研究了支气管扩张症-COPD 重叠综合征（BCOS）患者发生急性呼吸事件的风险。
方法
我们纳入了 2000 年至 2007 年台湾纵向健康保险数据库中 COPD 和支气管扩张症诊断患者 3955 例作为 BCOS 队列。在对照队列中，我们纳入了年龄、性别和指数年与每位 BCOS 患者匹配的 COPD 但无支气管扩张症患者，比例为 4:1。我们对两个队列随访 5 年，以研究 BCOS 队列与对照队列相比急性呼吸事件的发生率和风险，采用泊松回归模型确定发生率比（IRR）及其相应的 95%置信区间（CI）。
结果
BCOS 队列发生急性呼吸事件的次数多于对照队列（16.4 比 5.52/100 人年）。在调整潜在混杂因素后，BCOS 队列发生肺炎的风险高 2.20 倍（校正 IRR=2.20，95%CI=2.06-2.34），发生急性加重的风险高 3.88 倍（校正 IRR=3.88，95%CI=3.64-4.13），发生急性呼吸衰竭的风险高 1.74 倍（校正 IRR=1.74，95%CI=1.47-2.06），发生心肺骤停的风险高 1.99 倍（校正 IRR=1.99，95%CI=1.81-2.20）。
结论
与无支气管扩张症的 COPD 患者相比，BCOS 患者发生急性呼吸事件的风险更高。
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