摘要
目的探讨长程型哮喘(LSA)和晚发型哮喘(LOA)两种临床表型的不同特点及预后控制水平的影响因素。方法回顾性选取门诊确诊或既往已确诊为哮喘及随访治疗满1年复诊的LSA和LOA患者各70例作为LSA组和LOA组,再根据哮喘控制测试(ACT)问卷评估情况将140患者分为控制良好组(89例)与控制不佳组(51例)。收集所有患者的人口统计学资料及临床资料并进行组间比较。采用多因素二元logistic回归分析探讨影响门诊老年哮喘患者预后控制水平的影响因素。采用受试者工作特征(ROC)曲线评估相关因素对门诊老年哮喘患者预后控制水平的诊断效能。结果LSA组过敏体质、过敏性鼻炎患者比例均高于LOA组,咳嗽患者比例及环境领域评分均低于LOA组(P<0.05)。控制良好组过敏体质、哮喘家族史、近1年加重次数>1次、近1月呼吸道感染、过敏性鼻炎、焦虑/抑郁患者比例及合并症数量、呼出气一氧化氮(FeNO)量水平均低于控制不佳组,文化教育程度大专及以上、规律吸入ICS+LABA患者比例均高于控制不佳组(P<0.05)。多因素二元logistic回归分析结果显示,近1年加重次数>1次、近1月呼吸道感染、焦虑/抑郁均是影响门诊老年哮喘患者预后控制水平的危险因素,文化教育程度大专及以上、规律吸入ICS+LABA是其保护因素(P<0.05)。ROC曲线分析结果显示,近1年加重次数>1次、焦虑或抑郁、近1月呼吸道感染、未规律吸入ICS+LABA、文化教育程度低于大专及以上单独预测对门诊老年哮喘患者预后控制水平的效能均小于这5项指标联合预测。结论过敏性体质、过敏性鼻炎在LSA发生率较高,咳嗽症状、mini-AQLQ环境领域评分在LOA较高。近1年加重次数>1次、近1月呼吸道感染、焦虑或抑郁是影响老年哮喘患者预后控制水平的独立危险因素,文化教育程度大专及以上、规律吸入ICS+LABA是其独立保护因素。
Objective To explore the different characteristics of the two clinical phenotypes of long⁃standing asthma(LSA)and late⁃onset asthma(LOA),as well as the influencing factors of prognosis control levels.Methods A retrospective selection was made of 70 patients with LSA and 70 patients with LOA who were diagnosed with asthma or previously diagnosed with asthma in the respiratory outpatient department and were followed up for treatment for one year and then returned for follow⁃up.According to the evaluation situation of the Asthma Control Test(ACT)questionnaire,140 patients were divided into well⁃controlled group(89 cases)and poorly controlled group(51 cases).The demographic and clinical data of all patients were collected and compared between groups.Multivariate binary logistic regression analysis was used to explore the influencing factors of prognosis control levels in elderly outpatients with asthma.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of related factors for the prognosis control level of outpatients with elderly asthma.Results The proportion of patients with allergic constitution and allergic rhinitis in LSA group was higher than that in LOA group,while the proportion of patients with cough and the score of environmental domain were lower than those in LOA group(P<0.05).The proportion of patients with allergic constitution,family history of asthma,more than one exacerbation in the past year,respiratory tract infection in the past month,allergic rhinitis,anxiety or depression,the number of comorbidities and fractional exhaled nitric oxide(FeNO)level in well⁃controlled group were all lower than those in poorly⁃controlled group,while the proportion of patients with college education or above and regular inhalation of ICS+LABA was higher than that in poorly⁃controlled group(P<0.05).Multivariate binary logistic regression analysis results showed that the number of exacerbations in the past year>1,respiratory tract infection in the past month and anxiety or depression were risk factors for the prognosis control levels of elderly outpatients with asthma,while educational level of junior college or above and regular inhalation of ICS+LABA were protective factors(P<0.05).The ROC curve analysis results showed that the efficacy of individual predictions for the prognosis control levels of elderly outpatients with asthma,such as the number of exacerbations>1 in the past year,anxiety or depression,respiratory tract infection in the past month,irregular inhalation of ICS+LABA and educational level below junior college or above was less than that of the combined prediction of these 5 indicators.Conclusion Allergic constitution and allergic rhinitis show higher prevalence in LSA,while cough symptoms and mini-AQLQ environmental domain scores are higher in LOA.Independent risk factors affecting prognosis control in elderly asthma patients include>1 exacerbation in the past year,respiratory infection in the past month,and anxiety or depression.Independent protective factors include college education or higher and regular inhaled ICS+LABA therapy.
作者
郭浩杰
刘英丽
朱莉
齐咏
Guo Haojie;Liu Yingli;Zhu Li;Qi Yong(Department of Respiratory and Critical Care Medicine,Zhengzhou University People’s Hospital,Zhengzhou 450003,China;不详)
出处
《临床内科杂志》
2025年第10期833-837,共5页
Journal of Clinical Internal Medicine
基金
河南省中青年卫生健康科技创新领军人才培养项目(YXKC2020005)。
关键词
老年哮喘
长程型哮喘
晚发型哮喘
预后控制水平
影响因素
Asthma in the elderly
Long-standing asthma
Late-onset asthma
Level of prognosis control
Influencing factors
