摘要
目的探讨277例弥漫性实质性肺疾病住院患者死亡的影响因素。方法本院呼吸内科弥漫性实质性肺疾病(DPLD)的病例依据病因分为结缔组织疾病相关DPLD组(CTD-IP)、其他已知病因DPLD组和特发性间质性肺炎(IIPS)组,每组按预后情况分又为非死亡组和死亡组两个亚组,采用病例对照的研究方法进行风险因素回顾性分析。结果 IIPS组死亡亚组年龄平均、基础疾病患病率及CRP、ALT、AST指标高于非死亡组,CTD-IP组死亡亚组的CRP、WBC、AST指标高于非死亡组,其他病因组两亚组的病因构成提示有统计学差异,其死亡亚组CRP、PT、APTT、ALT、AST高于非死亡组。将上述各组指标进行曲线分析,AUC大于0.7指标作为死亡风险预测指标,并计算出其截断点作为最佳诊断阈值纳入多因素logistics回归分析。结果显示IIPS组中CRP>40(mg/L)和年龄>70(岁)、CTD-IP中CRP>40(mg/L)、其他组中CRP>50(mg/L)为独立死亡危险因素。结论 CRP升高、高龄及药物继发性DPLD是弥漫性实质性肺疾病患者住院死亡的危险因素,其中前者是DPLD患者的共同危险因素,而后两者分别是IIPS组和其他病因组的独立危险因素。上述因素在用于预测不同类型DPLD患者死亡风险中需区别分析。
Objective To explore the death risk factors of 277 cases of diffuse parenchymal lung disease （DPLD） in the hospital. Methods According to the etiology, the patients with interstitial lung disease were divided into 4 groups： connective tissue disease associated DPLD group （CTD-IP group ）, idiopathic interstitial pneumonia （IIPS） group and other known cause associated DPLD group. And each group was further divided into non-death subgroup and death subgroup. All cases were analyzed retrospectively with a case-control study method. Results In the IIPS group, the average age, basic disease prevalence rate, C-reactive protein （ CRP）, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） in the death subgroup were higher than those in the non-death subgroup. In the CTD-IP group, the CRP, white blood cell （WBC） and AST in the death subgroup were higher than those in the non-death subgroup. In the other known cause associated DPLD group, the CRP, prothrombin time （PT）, activated partial thromboplastin time （ APTT）, ALT and AST in the death subgroup were higher than those in the non-death subgroup, and the difference of etiologies between two subgroups was significant. The above indexes with AUC higher than 0.7 in curve analysis were taken as death risk forecast indexes, and the calculated cutoff points were taken as the bestdiagnostic thresholds. Multiple logistic regression analysis showed that independent risk factors were CRP 〉 40 mg/L and age 〉 70 years old in the IIPS group, CRP 〉 40 mg/L in the CTD-IP group, and CRP 〉 50 mg/L in the other known cause associated DPLD group. Conclusion Elevated CRP, advanced age and drug-induced DPLD are death risk factors of DPLD patients in the hospital. The elevated CRP is common death risk factor for DPLD patients, and the advanced age and drug-induced DPLD are independent risk factors for the IIPS group and the other known cause-associated DPLD group, respectively. When the factors are used to predict the death risk of
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第6期642-646,共5页
Journal of Third Military Medical University
基金
国家自然科学基金(81270130)~~
