摘要
目的 本研究旨在探讨吸入糖皮质激素(ICS)对慢性阻塞性肺疾病(COPD)合并社区获得性肺炎(CAP)(COPD-CAP)患者不良结局的影响。方法 回顾性收集2021年1月至2023年1月在温州市中西医结合医院呼吸科就诊的COPDCAP患者临床资料,根据是否行ICS治疗分为ICS组和非ICS组。采用单因素分析比较两组一般资料、影像学结局(肺部多叶浸润和胸腔积液)和临床结局[无创机械通气、有创机械通气、入住重症监护室(ICU)和30 d死亡率]的差异;采用Logistic回归探讨ICS与影像学结局和临床结局的关系。结果 共纳入120例COPD患者,其中ICS组38例,非ICS组82例。ICS组COPD-CAP患者的慢性阻塞性肺病全球倡议(GOLD)分级、肺炎严重性指数(PSI)分级和CURB-65评分均低于非ICS组(P <0.05)。多因素Logistic回归结果显示,使用ICS可降低肺部多叶浸润[OR=0.291,95%CI(0.123,0.687),P=0.005]、胸腔积液[OR=0.309,95%CI(0.105,0.908),P=0.033]、无创机械通气[OR=0.040,95%CI (0.012,0.129),P <0.001]、有创机械通气[OR=0.099,95%CI(0.013,0.783),P=0.028]、入住ICU[OR=0.207,95%CI(0.056,0.762),P=0.018]和30 d死亡率[OR=0.179,95%CI(0.039,0.822),P=0.027]的发生风险。结论 使用ICS可降低因CAP住院的COPD患者的肺部多叶浸润发生、胸腔积液、机械通气使用、ICU入住和30 d死亡率的发生风险。
Objective To investigate the effect of inhaled corticosteroids(ICS) on adverse outcomes in chronic obstructive pulmonary disease(COPD)(COPD-CAP) patients with community-acquired pneumonia(CAP).MethodsThe clinical data of COPDCAP patients who visited the respiratory department of respiratory of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2021 to January 2023 was retrosspective collected.They were divided into an ICS group and a non ICS group based on whether they were eligible for ICS treatment.A univariate analysis was used to compare the differences in general data,imaging outcomes(multilobed infiltration and pleural effusion),and clinical outcomes(non-invasive mechanical ventilation,invasive mechanical ventilation,ICU admission,and 30-day mortality) between two groups.The Logistic regression was used to explore the relationship between ICS and imaging and clinical outcomes.Result A total of 120 COPD patients were included in this study,including 38 in the ICS group,62 in the non ICS group.The univariate results showed that COPD-CAP patients in the ICS group had lower GOLD scores,PSI scores,and CURB-65 scores(P<0.05).The multivariate Logistic regression showed that the use of ICS reduces the risk of multi leaf infiltration [OR=0.291,95%CI(0.123,0.687),P=0.005],pleural effusion [OR=0.309,95%CI(0.105,0.908),P=0.033],non-invasive mechanical ventilation [OR=0.040,95%CI(0.012,0.129),P<0.001],invasive mechanical ventilation [OR=0.099,95%CI(0.013,0.783),P=0.028],ICU occupancy [OR=0.207,95%CI(0.056,0.762),P=0.018],and 30-day mortality [OR=0.179,95%CI(0.039,0.822),P=0.027].Conclusion ICS reduces the risk of multilobed infiltration,pleural effusion,mechanical ventilation usage,ICU occupancy,and 30-day mortality in COPD patients admitted to CAP.
作者
陈志博
俞宁宁
林圣乐
Zhi-Bo CHEN;Ning-Ning YU;Sheng-Le LIN(Department of Respiratory Medicine,Wenzhou Integrated Traditional Chinese and Western Medicine Hospital,Wenzhou 325000,Zhejiang Province,China)
出处
《中国药师》
CAS
2023年第11期279-285,共7页
China Pharmacist
关键词
慢性阻塞性肺疾病
社区获得性肺炎
吸入糖皮质激素
预后
Chronic obstructive pulmonary disease
Community-acquired pneumonia
Inhaled corticosteroids
Prognosis
