老年支气管扩张症患者预后影响因素分析

Analysis of prognostic factors in elderly patients with bronchiectasis

中文关键词: 老年, 支气管扩张症, 预后, 影响因素, 营养水平, 肺功能, 既往病史

英文关键词: elderly  bronchiectasis  prognosis  influencing factor  nutrient level  lung function  past medical history

中文摘要:

      目的 分析老年支气管扩张症患者不良预后因素,以期为临床患者诊疗提供思路.方法 回顾性选择2021年1月-2023年9月在首都医科大学附属北京康复医院接受治疗的老年支气管扩张症150例患者,记录临床基线资料、实验室指标、肺功能、随访期间患者的疗效和死亡情况等.将出院后90 d内再次急性发作入院者和死亡者纳入预后不良组,剩余患者则纳入预后良好组.结果 预后不良组与预后良好组年龄、性别、吸烟史、BMI、臂围、糖尿病病史、高血压病史、冠心病史、支气管哮喘病史、血清WBC、Hb、中性粒细胞、血小板计数、嗜酸性粒细胞、血气指标(PaCO2、PaO2、pH)、FEV1/FVC比值差异均无统计学意义(P＞0.05).预后不良组与预后良好组病程、咯血史、既往肺结核病史、合并COPD、脐上皮下脂肪厚度、血清ALB水平、FEV1％pred、FVC水平差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,脐上皮下脂肪厚度[OR=3.153,95％CI=(1.335～7.502)]、FEV1％pred[OR=6.022,95％CI=(1.890～14.254)]、咯血史[OR=4.817,95％CI=(1.455～9.659)]、肺结核病史[OR=4.135,95％CI=(1.419～8.224)]、ALB 水平[OR=2.853,95％CI=(1.109～6.830)]为影响患者不良预后的独立影响因素(P＜0.05).结论 患者不良预后的影响因素较多,临床应针对患者的既往病史、营养状况、肺功能情况等采取有针对性的干预措施,以改善患者的预后.

英文摘要:

      Objective To analyze the adverse prognostic factors of elderly patients with bronchiectasis,and provide ide-as for their clinical diagnosis and treatment.Methods 150 elderly patients with bronchiectasis who received treatment in Bei-jing Rehabilitation Hospital Affiliated to Capital Medical University from January 2021 to September 2023 were retrospectively selected.Their clinical baseline data,laboratory indicators,lung function were recorded.Their efficacy and death during the follow-up period were recorded.The patients who were admitted to hospital because of acute attack again or died within 90 days after discharge were included in the poor prognosis group,and the remaining patients were included in the good prognosis group.Results There were no significant differences in age,sex,BMI,arm circumference,histories of smoking,diabetes,hypertension,coronary heart disease and bronchial asthma,the levels of serum WBC,Hb,neutrophil,platelet count,eosino-phils,blood gas indices(PaCO2,PaO2,pH)and FEV1/FVC ratio between the two groups(P＞0.05).There were signifi-cant differences in the course of disease,histories of hemoptysis and pulmonary tuberculosis,concomitant COPD,thickness of umbilical subepithelial fat,the levels of serum ALB,FEV1％pred and FVC between the two groups(P＜0.05).Multivariate logistic regression analysis showed that the thickness of umbilical subepithelial fat[OR=3.153,95％CI=(1.335-7.502)],FEV1％pred[OR=6.022,95％CI=(1.890-14.254)],history of hemoptysis[OR=4.817,95％CI=(1.455-9.659)],history of pulmonary tuberculosis[OR=4.135,95％CI=(1.419-8.224)]and ALB level[OR=2.853,95％CI=(1.109-6.830)]were independent influencing factors for poor prognosis(P＜0.05).Conclusion There are many factors affecting the poor prognosis of patients.In clinical practice,targeted intervention measures should be taken according to their past medi-cal history,nutritional status,lung function,etc.to improve their prognosis.