摘要
目的探讨超重慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床特征和危险因素。方法该项前瞻性横断面研究,收集了本院从2022年7月-2023年1月的AECOPD住院患者284例。根据患者的BMI分为正常体重组180例和超重组104例。收集了包括一般资料、基础疾病、感染指标、血常规、血气分析、肝肾功能和肺功能等变量数据。对数据进行单因素分析和共线性分析后,将差异变量纳入二元Logistic回归建立模型,并采用nomogram及相关曲线对Logistic回归结果进行验证和可视化。结果单因素分析显示两组患者的吸烟状况、2型糖尿病(T2DM)、冠心病(CAD)和原发性高血压发病率、谷丙转氨酶(ALT)有统计学差异(均P<0.05)。将上述5个变量建立二元Logistic回归方程(C-index=0.659),结果显示吸烟状况(目前吸烟)、T2DM和ALT与AECOPD患者超重独立相关。用nomogram及相关曲线对Logistic回归结果进行验证和可视化。效应曲线MAE为0.02和ROC曲线的AUC为0.658,提示该模型具有良好的预测一致性和准确性。DCA曲线显示nomogram的风险阈值在0.15~0.78时该模型的预测净获益>0,提示有较好的临床预测价值。结论本研究的数据显示与正常体重的AECOPD患者相比,超重的AECOPD患者吸烟率更低,合并2型糖尿病和原发性高血压更普遍,ALT更高。提示超重的AECOPD患者合并症更多,预后可能较差,需密切监测病情变化及早期给予更有力的临床干预措施。
Objective To explore clinical features and risk factors for acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients with overweight.Methods In this prospective cross-sectional study,284 patients with AECOPD were enrolled from July 2022 to January 2023.The patients were divided into normal weight group(BMI 18.5~23.9,n=180)and overweight group(BMI≥24,n=104).Demographic data,underlying diseases,inflammatory parameters,blood routine,arterial blood gas(ABG),renal function,and lung function were collected.Binary logistics regression was performed to explore the independent risk factors for overweight in patients with AECOPD.Furthermore,nomogram and its-associated curves were utilized to verify and visualize the model.Results Univariate analysis showed that smoking,the rates of type 2 diabetes(T2DM),coronary artery disease(CAD)and essential hypertension,and alanine aminotransferase(ALT)were significantly different between two groups(P in all<0.05).Subsequently,a binary logistic regression model identified that current-smoking,the rate of T2DM,and ALT were independent variables of overweight in AECOPD patients.Additionally,the result of binary logistic regression was visualized and verified by nomogram and its-associated curves.Then,the mean absolute error(MAE)of calibration curve and the AUC of ROC curve were 0.02 and 0.658,respectively.The DCA curve revealed that the nomogram had more clinical benefits if the threshold at a range of 0.15~0.78.Conclusion Collectively,this study found that compared to normal weight AECOPD,overweight AECOPD patients had less smoking.Meanwhile,T2DM and essential hypertension were more common,and ALT was higher in AECOPD patients with overweight than those with normal weight.These results indicate that AECOPD patients with overweight are inclined to combine with more comorbidities,potentially leading to worse outcomes.Therefore,advanced management and clinical care should be given to AECOPD patients with overweight.
作者
何高燕
王汉超
罗晓斌
赵勇
姚宇
王小川
李丽
杨艳
熊伟
朱涛
HE Gaoyan;WANG Hanchao;LUO Xiaobin;ZHAO Yong;YAO Yu;WANG Xiaochuan;LI Li;YANG Yan;XIONG Wei;ZHU Tao(Respiratory Medicine and Critical Care Medicine,Suining Central Hospital,Suining 629000,Sichuan,China;Research Management Department,Suining Central Hospital,Suining 629000,Sichuan,China)
出处
《西部医学》
2026年第1期71-75,共5页
Medical Journal of West China
基金
四川省自然科学基金项目(2023NSFSC0536)
四川省卫生健康委员会科技项目(临床研究专项)(23LCYJ008)
中华国际医学交流基金会呼吸疾病青年实用研究项目(Z-2017-24-2031)
四川大学-遂宁市校市战略合作“揭榜性帅”科技项目(2024CDSN-18)。
关键词
慢性阻塞性肺疾病急性加重期
超重
合并症
2型糖尿病
原发性高血压
谷丙转氨酶
吸烟
Acute exacerbation of chronic obstructive pulmonary disease
Overweight
Comorbidities
Type 2 diabetes
Essential hypertension
Alanine aminotransferase
Smoking
