Yu Songsong, Fang Qiuhong, Li Yinjuan
Department of Emergency, Beijing Shijitan Hospital.
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital.
Medicine (Baltimore). 2018 Oct;97(42):e12844. doi: 10.1097/MD.0000000000012844.
Acute exacerbations (AE) affect the prognosis of hospitalized patients with chronic obstructive pulmonary disease (COPD). Pneumonia further affects their prognosis and early diagnosis of pneumonia in AECOPD is important to initiate treatments. This study aimed to examine the differences between hospitalized AECOPD patients with and without pneumonia in order to identify risk factors of pneumonia among hospitalized patients with AECOPD.This was a retrospective case-control study of patients with COPD hospitalized at the respiratory ward of Beijing Shijitan Hospital, Capital Medical University, from October 2010 to October 2013. Patients were divided into the pneumonia and nonpneumonia groups based on exudations or opacities on chest computed tomography (CT) at admission. Data were analyzed using the chi-square test and independent 2-sample ANOVA in SPSS 20.0. Logistic regression analysis was used to identify the factors independently associated with pneumonia. P < .05 was considered statistically significant.A total of 164 patients were included. Smoking history (OR = 2.646, 95%CI 1.153-6.074, P = .022), use of drugs during the stable stage (OR = 0.435, 95%CI 0.216-0.877, P = .020), D-dimer levels (OR = 1.001, 95%CI 1.000-1.002, P = .049), percentage of neutrophils (OR = 0.271, 95%CI 0.078-0.940, P = .040), and magnitude of neutrophils increase (OR = 0.946, 95%CI 0.896-0.999, P = .046) were independently associated with pneumonia in patients with AECOPD. For severe and very severe COPD patients, smoking history (OR = 4.426, 95%CI 1.458-13.435, P = .009), use of drugs during the stable stage (OR = 0.384, 95%CI 0.168-0.877, P = .042), and fever (OR = 0.426, 95%CI 0.187-0.969, P = .023) were independently associated with pneumonia.Smoking history, use of drugs during the stable stage, and percentage of neutrophils are independently associated with CT-diagnosed pneumonia among hospitalized AECOPD patients.
急性加重（AE）影响慢性阻塞性肺疾病（COPD）住院患者的预后。肺炎进一步影响其预后，AECOPD患者肺炎的早期诊断对于启动治疗很重要。本研究旨在探讨合并或未合并肺炎的AECOPD住院患者之间的差异，以确定AECOPD住院患者肺炎的危险因素。
这是一项对2010年10月至2013年10月在首都医科大学附属北京世纪坛医院呼吸内科住院的COPD患者进行的回顾性病例对照研究。根据入院时胸部计算机断层扫描（CT）的渗出或混浊情况将患者分为肺炎组和非肺炎组。使用SPSS 20.0软件进行卡方检验和独立样本t检验分析数据。采用Logistic回归分析确定与肺炎独立相关的因素。P<0.05被认为具有统计学意义。
共纳入164例患者。吸烟史（OR=2.646，95%CI 1.153-6.074，P=0.022）、稳定期用药情况（OR=0.435，95%CI 0.216-0.877，P=0.020）、D-二聚体水平（OR=1.001，95%CI 1.000-1.002，P=0.049）、中性粒细胞百分比（OR=0.271，95%CI 0.078-0.940，P=0.040）以及中性粒细胞升高幅度（OR=0.946，95%CI 0.896-0.999，P=0.046）与AECOPD患者的肺炎独立相关。对于重度和极重度COPD患者，吸烟史（OR=4.426，95%CI 1.458-13.435，P=0.009）、稳定期用药情况（OR=0.384，95%CI 0.168-0.877，P=0.042）以及发热（OR=0.426，95%CI 0.187-0.969，P=0.023）与肺炎独立相关。
吸烟史、稳定期用药情况以及中性粒细胞百分比与AECOPD住院患者CT诊断的肺炎独立相关。
