摘要
目的分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)伴心力衰竭(heart failure,HF)患者继发肺部感染的危险因素。方法选择2023年1月至2024年12月我院收治的76例COPD伴HF患者为对象,根据是否发生肺部感染分组,继发肺部感染31例为观察组,未继发肺部感染45例为对照组。收集患者临床资料,分析肺部感染发生情况,使用多因素Logistic回归分析COPD伴HF患者继发肺部感染的影响因素,绘制列线图,分析预测价值。结果观察组患者糖尿病史26例(83.87%)、长期使用糖皮质激素或抗生素25例(80.65%)高于对照组糖尿病史10例(22.23%)、长期使用糖皮质激素或抗生素15例(33.33%),观察组白蛋白(34.70±4.55)g/L低于对照组(39.58±4.60)g/L(P<0.05)。Logistic回归分析显示,糖尿病史(OR=1.050,95%CI:1.024~1.077)、长期使用糖皮质激素或抗生素(OR=1.104,95%CI:1.043~1.169)、血清白蛋白(OR=0.850,95%CI:0.792~0.912)为COPD伴HF继发肺部感染的危险因素(P<0.05)。按7︰3拆分训练集与验证集,训练集53例和验证集23例预测COPD伴HF继发肺部感染受试者特征曲线(receiver operating characteristic,ROC)的曲线下面积(area under the curve,AUC)(95%CI)分别为0.88(0.77~0.98)和0.90(0.77~1.00);列线图预测COPD伴HF继发肺部感染校正曲线趋近于理想曲线(P=0.449、0.188);DCA曲线显示列线图概率阈值20%~85%具有正向净收益。76例COPD伴HF患者中生存70例,死亡6例,其中2例因肺部感染死亡,2例因急性呼吸衰竭死亡,2例因恶性心律失常死亡。结论有糖尿病史、长期使用糖皮质激素或抗生素、低白蛋白水平为COPD伴HF患者继发肺部感染的危险因素。
Objective To analyze the risk factors for secondary pulmonary infection in patients with chronic obstructive pulmonary disease(COPD)complicated by heart failure(HF).Methods All of 76 COPD patients with HF admitted to our hospital from January 2023 to December 2024 were selected as subjects.They were divided into groups based on the occurrence of pulmonary infection:31 patients with secondary pulmonary infection were assigned to the observation group,and 45 patients without secondary infection were assigned to the control group.Clinical data were collected,and the occurrence of pulmonary infection was analyzed.Multivariate Logistic regression analysis was used to identify the influencing factors for secondary pulmonary infection in COPD patients with HF.A nomogram was constructed,and its predictive value was analyzed.Results In the observation group 26 cases(83.87%)had a higher prevalence of diabetes history and 25 cases(80.65%)long-term use of glucocorticoids or antibiotics compared to the control group diabetes history 10 cases(22.23%);long-term glucocorticoid/antibiotic use 15 cases(33.33%).Serum albumin levels were lower in the observation group(34.70±4.55)g/L than in the control group(39.58±4.60)g/L(P<0.05).Logistic regression analysis identified diabetes history(OR=1.050,95%CI:1.024~1.077),long-term use of glucocorticoids or antibiotics(OR=1.104,95%CI:1.043~1.169),and serum albumin level(OR=0.850,95%CI:0.792~0.912)as risk factors for secondary pulmonary infection in COPD patients with HF(P<0.05).The dataset was split into a training set(53 cases)and a validation set(23 cases)in a 7︰3 ratio.The area under the curve(AUC)(95%CI)of receiver operating characteristic(ROC)curve for predicting secondary pulmonary infection was 0.88(0.77~0.98)in the training set and 0.90(0.77~1.00)in the validation set.The calibration curve of the nomogram for predicting secondary pulmonary infection approximated the ideal curve(P=0.449,0.188).Decision curve analysis(DCA)showed a positive net benefit within the nomogram probability threshold range of 20%to 85%.Among the 76 COPD patients with HF,70 survived and 6 died,with 2 deaths due to pulmonary infection,2 due to acute respiratory failure,and 2 due to malignant arrhythmia.Conclusion History of diabetes,long-term use of glucocorticoids or antibiotics,and low serum albumin levels are risk factors for secondary pulmonary infection in COPD patients with HF.
作者
同娟
乔燕
田丹
高萌
毛书祥
杨洋
Tong Juan;Qiao Yan;Tian Dan;Gao Meng;Mao Shuxiang;Yang Yang(Department of Cardiovascular Medicine,Xijing Hospital Affiliated to Air Force Medical University,Xi′an 710032,China;Department of Respiratory Medicine,Xijing Hospital Affiliated to Air Force Medical University,Xi′an,Shaanxi 710032,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第4期516-520,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
陕西省重点研发计划(S2024-YF-YBGY-150)。
关键词
肺疾病
慢性阻塞性
心力衰竭
肺部感染
危险因素
Chronic obstructive pulmonary disease
Heart failure
Pulmonary infection
Risk factors
