摘要
目的 分析慢性阻塞性肺疾病（COPD）患者的死亡原因及影响其首次因COPD急性加重（AECOPD）住院后生存时间的危险因素.方法 检索2006年1月至2008年12月收治、病案首页的主要诊断或次要诊断为COPD（ICD-10编码为J40-J47）的495例患者的临床资料,对其中67例死亡患者的病例资料进行回顾性分析,由专科高年资医师重新审核,纠正错误分类后,按国际疾病分类ICD-10进行编码统计.采用直接死因的启动原因即根本死因进行全死因构成及顺位分析.查阅死亡病例首次因AECOPD住院的临床资料,计算首次住院后的生存时间,进行Cox回归生存分析.结果 67例死亡COPD患者,死亡前12个月内第一秒用力呼气量（FEV1）占预计值百分比中位数为34%.患者死因构成：呼吸系统疾病39例（5 8.2%）;心脑血管疾病16例（23.9%）;恶性肿瘤10例（14.9%）;糖尿病1例（1.5%）,自杀1例（1.5%）.67例死亡患者中,13例直至死亡从未因AECOPD住院,其余54例死亡距离其首次因AECOPD住院后的生存时间为1～159个月,平均38个月.54例患者Cox回归分析结果表明,合并缺血性心脏病、合并重度肺动脉高压、年龄、体质指数（BMI）、血清C反应蛋白（CRP）水平是影响生存时间的独立危险因素（均P＜0.05）.结论 呼吸系统疾病是中-重度COPD患者主要的死亡原因,其次为心脑血管疾病和恶性肿瘤.合并缺血性心脏病、合并重度肺动脉高压、年龄、BMI、血清CRP水平是影响其首次因AECOPD住院后生存时间的独立危险因素.
Objective To study the causes of chronic obstructive pulmonary disease （COPD）related death and influencing factors of survival time from first hospitalization due to acute exacerbation of chronic obstructive pulmonary disease （AECOPD）.Methods All patients with a primary or secondary diagnosis of COPD （International Classification of Diseases （ICD）-10 Codes J40-J47） were continuously enrolled at our hospital from January 2006 to December 2008.A retrospective review was performed on the medical records of COPD patients who died during hospitalization.The causes of death were coded and analyzed according to the International Classification of Diseases （ICD） -10.The underlying causes of death were identified and ranked in order of prevalence.The medical records of first hospitalization due to AECOPD were reviewed.Retrospective analysis was performed for the clinical data.And Cox regression analysis was used to select the independent risk factors of influencing the survival time.Results Sixtyseven patients died during hospitalization.The median FEV1 （forced expiratory volume in 1 second percentage） was 34%.The causes of death in the COPD inpatients were as follows：respiratory diseases （ n = 39）,cardiocerebrovascular diseases （ n = 16）,malignant tumors （ n = 10）,diabetes mellitus （ n = 1 ）and suicide （n = 1 ）.Among them,54 patients had a history of hospitalization due to AECOPD.Thirteen deceased patients were never hospitalized because of AECOPD.The mean interval between the first admission with AECOPD as the primary diagnosis and death was 38 months （range：1 - 159）.The independent risk factorsof influencing the survival time were as follows：complications with coronary artery disease ＆ severe pulmonary hypertension,age,body mass index （ BMI ） and serum level of C-reactive protein （CRP） （all P 〈0.05） .Conclusion The major cause of death in moderate-severe COPD patients is respiratory disease.complicated with coronary artery disease ＆ severe pulmonary hypertension,age,BMI and serum level of CRP are the independent risk factors of affecting the survival time from first hospitalization due to AECOPD.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第12期824-827,共4页
National Medical Journal of China
基金
中华医学会临床医学科研专项资金项目（07010440052）
关键词
肺疾病
慢性阻塞性
死亡原因
生存时间
Pulmonary disease,chronic obstructive
Cause of death
Survival time
