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慢性阻塞性肺疾病合并症预示高死亡率——哮喘-慢性阻塞性肺疾病重叠综合征预后较好。

COPD Comorbidities Predict High Mortality - Asthma-COPD-Overlap Has Better Prognosis.

作者信息

Peltola Lotta, Pätsi Heikki, Harju Terttu

机构信息

Oulu University Hospital, Department of Medicine, Respiratory Unit and MRC Oulu, Respiratory Research Group, University of Oulu and Oulu University Hospital, Oulu, Finland.

出版信息

COPD. 2020 Aug;17(4):366-372. doi: 10.1080/15412555.2020.1783647. Epub 2020 Jun 30.

Abstract

The purpose of this study was to investigate the characteristics and survival of patients with COPD and asthma-COPD overlap (ACO) and how these patient groups differ from each other. We examined the impact of different comorbidities, multimorbidity, lung function and other factors have on survival in COPD and ACO patients. We also examined the causes of death to determine how many patients die of other than respiratory diseases. This retrospective study includes 214 patients with an exacerbation of COPD requiring hospitalisation during the year of 2005. The patients were followed up until the end of year 2015. The survival of ACO patients was significantly higher than COPD patients (4.7 vs. 1.7 years,  = 0.001). Poor lung function predicted worse survival in both patient groups, but the prognosis was still better in ACO patients with both FEV1 over and under 50% of predicted (median survival 8.4 years vs. 5.8 years,  < 0.001) compared to COPD (4.9 and 3.1 years, respectively). In this study setting, the negative effect of having three or more comorbidities on survival was significant in both groups. We didn't see major differences in the profiles of comorbidity patterns, in the underlying cause of deaths or in the pulmonary functions between ACO and COPD groups at the beginning of follow-up. Patients with a BMI over 25 seemed to have a trend for better survival ( = 0.055), but no differences were found between ACO and COPD groups.

摘要

本研究的目的是调查慢性阻塞性肺疾病(COPD)和哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者的特征及生存情况,以及这些患者群体之间的差异。我们研究了不同合并症、多种合并症、肺功能及其他因素对COPD和ACO患者生存的影响。我们还研究了死亡原因,以确定有多少患者死于呼吸系统疾病以外的原因。这项回顾性研究纳入了2005年因COPD急性加重而需住院治疗的214例患者。对这些患者进行随访直至2015年底。ACO患者的生存期显著长于COPD患者(4.7年对1.7年,P = 0.001)。肺功能差预示着两组患者的生存期更差,但与COPD患者(分别为4.9年和3.1年)相比,预计第一秒用力呼气容积(FEV1)超过和低于预计值50%的ACO患者预后仍更好(中位生存期分别为8.4年和5.8年,P < 0.001)。在本研究中,有三种或更多合并症对生存的负面影响在两组中均显著。在随访开始时,我们未发现ACO组和COPD组在合并症模式、死亡的潜在原因或肺功能方面存在重大差异。体重指数(BMI)超过25的患者似乎有生存期更好的趋势(P = 0.   055),但ACO组和COPD组之间未发现差异。

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