Objective: To study the association between comorbidity and acute exacerbation risk in patients with chronic obstructive pulmonary disease (COPD). Methods: This was a prospective cohort study with 64 stable COPD patients included. There were 64 males and 18 females with an average age of (68±9) years. Clinical characteristics, the number and type of comorbidities were recorded, and Charlson comorbidity index (CCI) was calculated. The patients were interviewed by phone calls every 3 months since baseline in which the number of acute exacerbations was recorded until 12 months. The impact of CCI, the number of comorbidities and certain comorbidities in the prediction of COPD exacerbation risk were analyzed. Results: Compared to patients with a lower CCI score, patients with a higher CCI score were older (75±6 vs 62±8), and had more severe lung function impairment [FEV(1)%pred: (40±18)% vs (52±18)% ], higher number of comorbidities [4(3, 7) vs 1(1, 3)] and higher frequency of hospital admission due to acute exacerbation [1(0, 2) vs 0(0, 0.25)]. In comparison with patients with lower number of comorbidities, patients with higher number of comorbidities were older (72±7 vs 64±10), and had higher mMRC score [2(1, 3) vs 2(1, 2)] and more severe lung function impairment [FEV(1)%pred: (42±15)% vs (53±19)% ], higher age adjusted CCI score [5(3, 5) vs 3(2, 3) ] and more courses of systemic corticosteroids [2(0, 3) vs 0(0, 0.75)] and/or antibiotics use [3(2, 4) vs 1.5(1, 2.75)]. The number of hospitalizations and total number of exacerbations were higher in COPD patients with bronchiectasis than those without (P<0.005). Conclusion: The inclusion of clinically meaningful comorbidities into the combined assessment of COPD for the prediction of disease prognosis deserves further study.
目的： 探讨慢性阻塞性肺疾病(慢阻肺)共患疾病与1年急性加重风险的关系。 方法： 前瞻性顺序纳入四川大学华西医院中西医结合科就诊的2014年5月至2015年12月233例慢阻肺患者，排除其中肺癌、肺结核、支气管哮喘及闭塞性细支气管炎患者13例，220例中64例慢阻肺稳定期患者，其中男46例，女18例，年龄47～86岁，平均(68±9)岁。收集患者临床资料并统计共患疾病数量、种类及Charlson合并症指数(CCI)，根据CCI将患者分为高分组与低分组，比较2组临床表现，观察共患疾病数量和种类与患者肺功能的关系。对64例患者进行3个月1次的电话随访，记录至入组1年期间慢阻肺急性加重次数。 结果： CCI高分组[(75±6)岁]较低分组[(62±8)岁]年龄更大，肺功能更差[FEV(1)占预计值%分别为(40±18)%和(52±18)%]，伴随慢阻肺共患疾病种类更多[4(3, 7)、1(1, 3)]，高分组患者在随访期间因慢阻肺急性加重住院次数更多[1(0, 2)、0(0, 0.25)]。共患疾病种类更多的慢阻肺患者的评估改良呼吸困难量表评分更高[(2(1, 3)、2(1, 2)]、肺功能更差[FEV(1)占预计值%分别为(42±19)%和(53±19)%]，年龄校正后CCI评分更高[5(3, 5)、3(2, 3)]，随访期间全身糖皮质激素[2(0, 3)、0(0, 0.75)]及抗生素治疗次数更多[3(2, 4)、1.5(1, 2.75)]。伴随有支气管扩张的慢阻肺患者住院次数及急性加重总次数均高于不伴有支气管扩张者(P<0.05)。 结论： 慢阻肺患者共患疾病的种类以及如何评价共患疾病对慢阻肺的综合评估和预后判断的作用值得重视。.
Keywords: Comorbidity; Exacerbation; Prediction; Pulmonary disease, chronic obstructive.