摘要
目的分析长效支气管舒张剂治疗组合方案开始时间对慢性阻塞性肺疾病(COPD)急性加重的影响。方法回顾性选取2015年1月至2019年12月浙江省丽水市第二人民医院收治的初诊COPD患者180例,所有患者均使用了长效支气管舒张剂治疗组合方案治疗,并按照长效支气管舒张剂治疗组合方案开始时间进行分组。随访2组后续急性加重情况,采用单因素和多因素Cox回归控制混杂因素进一步验证长效支气管舒张剂治疗组合方案开始时间对COPD急性加重的影响。结果有79例在COPD确诊后≤30 d开始使用长效支气管舒张剂治疗组合方案,101例确诊后>30 d开始使用。随访期间共有53例(占29.4%)患者出现急性加重。Kaplan-Meier法分析结果发现,>30 d组累积急性加重率比≤30 d组高(Logrankχ^(2)=23.815,P<0.05)。单因素分析结果发现,除长效支气管舒张剂治疗组合方案开始时间>30 d外,当前吸烟、治疗前急性加重≥1次亦为COPD急性加重的独立危险因素,第1秒用力呼气容积占预计值百分比(FEV1%)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)为保护因素(P<0.05)。采用多因素分析控制吸烟等其他混杂因素的影响,结果发现>30 d组急性加重风险是≤30 d组的2.732倍[HR(95%CI):2.732(2.211,3.372),P<0.05]。结论诊断为COPD后≤30 d及时开始使用包含长效支气管扩张剂的治疗方案十分必要,可有效防止急性加重。
Objective To analyze the effect of the start time of a combination regimen of long-acting bronchodilator therapy on the acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods A total of 180 patients with primary COPD admitted to the Second People′s Hospital of Lishui from January 2015 to December 2019 were retrospectively selected,all patients were treated with the long-acting bronchodilator treat-ment combination scheme,and grouped according to the start time of the long-acting bronchodilator treatment combination scheme.The follow-up acute exacerbations of the two groups were compared,and univariate and mul-tivariate Cox regression were used to control confounders to further confirm the influence of the start time of the long-acting bronchodilator treatment combination on the acute exacerbations of COPD.Results A combination regimen of long-acting bronchodilator therapy was initiated in 79 cases≤30 days after the diagnosis of COPD,and in 101 cases>30 days after the diagnosis.A total of 53 patients(29.4%)had acute exacerbations during the follow-up period.Kaplan Meier analysis showed that the cumulative acute exacerbation rate in the>30 d group was higher than that in the≤30 d group(Log-rankχ^(2)=23.815,P<0.05).The results of univariate analysis showed that current smoking and acute exacerbation≥1 time before treatment were also independent risk factors for acute exacerbation of COPD,while FEV1%and FEV1/FVC were protective factors,except for the start of the combination regimen of long-acting bronchodilators>30 d(P<0.05).Multivariate analysis was used to control for the influence of other confounding factors such as smoking,and the risk of acute exacerbation in the>30 d group was 2.732 times than that in the≤30 d group[HR(95%CI):2.732(2.211,3.372),P<0.05].Conclusion It is necessary to start using a treatment regimen containing long-acting bronchodilators within 30 days after the diagnosis of COPD,which can effectively prevent acute exacerbation.
作者
李蓓蕾
吕雄胜
李媛媛
Li Beilei;Lyv Xiongsheng;Li Yuanyuan(Department of Geriatric,Second People′s Hospital of Lishui City,Lishui,Zhejiang323000,China)
出处
《中国药物与临床》
CAS
2023年第7期436-440,共5页
Chinese Remedies & Clinics
关键词
支气管扩张药
发病到治疗时间
肺疾病
慢性阻塞性
急性加重
Bronchodilator agents
Time-to-treatment
Pulmonary disease,chronic obstructive
Worsen-ing of the condition
