Clinical observation of patients with acute axcerbation of chronic obstructive pulmonary disease and patients with chronic obstructive pulmonary disease plus community-acquired pneumonia

doi:10.19983/j.issn.2096-8493.20210166

Abstract

Abstract: Objective: To compare the clinical manifestations of acute axcerbation of chronic obstructive pulmonary disease (AECOPD) and chronic obstructive pulmonary disease (COPD) plus community-acquired pneumonia (CAP),thus to improve clinical diagnosis and treatment and reduce case fatality rate of them.Methods: We retrospectively collected 101 cases with definite COPD diagnosis hospitalized in Department of Respiratory in The Second Xiangya Hospital of Central South University and The First Hospital of ShaoYang University between January 2017 and June 2017. They were divided into AECOPD group and COPD-CAP group according to their medical histories and results of chest CT examination. The general information, clinical symptoms, signs, inflammation index, nutritional status, and results of blood gas analysis, pulmonary function test results, complications, and clinical outcomes were compared between the two groups.Results: (1) The incidence of chill, fever, lung rales in COPD-CAP group were 15.3% (9/59), 27.1% (19/59), 83.1% (49/59) respectively, which were significant higher than that of AECOPD group (2.4% (1/42), 9.5% (4/42), 64.3% (27/42), χ ²=4.558, 3.448, 11.053, P=0.033, 0.043, 0.037). (2)In the COPD-CAP group, median/mean of CRP, PCT, ESR, BNP and PaCO₂ were 34.10 (7.37,79.30) mg/L, 0.17 (0.09,0.25) ng/ml, 32.00 (14.00,53.00)mm/1h、430.00 (140.00,2253.00)pg/ml, and (51.26±16.15)mmHg (1mmHg=0.133kPa) respectively, which were significant higher than that of the AECOPD group ((5.62 (2.94,13.95))mg/L, 0.10 (0.04,0.22)ng/ml, 18.50 (8.00,27.00)mm/1h、150.70 (100.00,547.00)pg/ml, and (45.71±9.94)mmHg, Z=-4.648,P=0.000;Z=-0.818,P=0.024;Z=-3.182,P=0.001;Z=-3.172,P=0.002;t=-3.621,P=0.035). The lung function of the two groups were all abnormally decreased,and the levels of FEV₁%pred and FEV₁/FVC% in the COPD-CAP group were (45.00±14.70)% and (50.28±7.31)%, which were lower than those in the AECOPD group ((52.02±15.42)%, (61.92±17.92)%), and the differences were statistically significant (t=5.124, 2.726, P=0.000, 0.047). (3) The occurrence rate of heart failure, mechanical ventilation, mortality in COPD-CAP group were 28.8% (17/59), 27.1% (16/59), and 6.8% (4/59),which were significantly higher than the AECOPD group (11.9% (5/42), 9.5% (4/42), 2.4% (1/42), χ²=1.719, 2.824, 0.059, P=0.042, 0.003, 0.027). The average length of stay in COPD-CAP group was (9.38±3.66) days, longer than AECOPD group ((6.28±2.04) days), the difference was statistically significant (t=-1.237,P=0.011).Conclusion: There were differences in clinical symptoms and signs between AECOPD group and COPD-CAP group. Compared with AECOPD group, hospitalized patients in COPD-CAP group got more obvious inflammatory reaction, more severe disease and worse prognosis, thus need to be closely monitored and timely treated in clinic practice.

Key words: Pulmonary disease, chronic obstructive, Pneumonia, Disease attributes

CLC Number:

R536

ZHU Dan, CHEN Yan, SHUANG Qing-cui, ZENG Hui-hui. Clinical observation of patients with acute axcerbation of chronic obstructive pulmonary disease and patients with chronic obstructive pulmonary disease plus community-acquired pneumonia[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(2): 118-124. doi: 10.19983/j.issn.2096-8493.20210166

Figures/Tables 3

临床特征	AECOPD组(42例)	COPD合并CAP组(59例)		统计检验值	P值
性别[例(构成比,%)]				χ²=0.944	0.944
女	3(7.1)	4(6.8)
男	39(92.9)	55(93.2)
年龄(岁,$\bar{x}$±s)	68.71±9.26	71.26±9.25		t=-1.199	0.233
吸烟[例(构成比,%)]				χ²=3.042	0.218
吸烟	28(66.6)	42(71.2)
无吸烟史	7(16.7)	11(18.6)
戒烟大于3年	7(16.7)	6(10.2)
咳痰[例(构成比,%)]				χ²=0.059	0.807
有	41(97.6)	57(96.6)
无	1(2.4)	2(3.4)
畏寒[例(发生率,%)]	1(2.4)	9(15.3)		χ²=4.558	0.033
发热[例(发生率,%)]	4(9.5)	16(27.1)		χ²=3.448	0.043
临床特征	AECOPD组(42例)		COPD合并CAP组(59例)	统计检验值		P值
胸痛[例(发生率,%)]	3(7.1)		2(3.4)	χ²=0.734		0.391
呼吸频率(次/min, $x ¯$ ±s)	22.59±2.67		22.44±2.66	t=0.223		0.824
体质量(kg, $x ¯$ ±s)	59.17±10.04		54.54±9.78	t=2.152		0.375
肺部啰音[例(发生率,%)]	27(64.3)		49(83.1)	χ²=11.053		0.001
双下肢水肿[例(发生率,%)]	10(23.8)		17(28.8)	χ²=0.314		0.575

实验室检查	AECOPD组(42例)	COPD合并CAP组(59例)	统计检验值	P值
WBC[×10⁹/L,M(Q₁,Q₃)]	6.93(5.31,10.34)	7.24(6.01,9.17)	Z=-0.544	0.586
N%( $x ¯$ ±s)	71.57±9.91	75.67±12.03	t=-1.814	0.073
CRP[mg/L,M(Q₁,Q₃)]	5.62(2.94,13.95)	34.10(7.37,79.30)	Z=-4.648	0.000
PCT[ng/ml,M(Q₁,Q₃)]	0.10(0.04,0.22)	0.17(0.09,0.25)	Z=-0.818	0.024
ESR[mm/h,M(Q₁,Q₃)]	18.50(8.00,27.00)	32.00(14.00,53.00)	Z=-3.182	0.001
HGB(g/L, $x ¯$ ±s)	133.43±26.55	125.64±21.22	t=1.636	0.105
ALB(g/L, $x ¯$ ±s)	38.05±4.09	33.18±4.06	t=5.930	0.207
ALT[IU/L,M(Q₁,Q₃)]	12.00(5.68,35.70)	13.2(9.50,26.00)	Z=-0.912	0.056
AST[IU/L,M(Q₁,Q₃)]	32.60(20.35,40.10)	20.3(15.30,27.80)	Z=-0.906	0.365
BUN(mmol/L, $x ¯$ ±s)	6.00±2.06	6.36±2.59	t=-0.599	0.549
SCr[μmol/L,M(Q₁,Q₃)]	75.90(68.43,87.10)	69.75(60.75,86.50)	Z=-1.645	0.100
BNP[pg/ml,M(Q₁,Q₃)]	150.70(100.00,547.00)	430.00(140.00,2253.00)	Z=-3.172	0.002
PaO₂ (mmHg, $x ¯$ ±s)	42.00±16.75	77.28±26.49	t=0.019	0.724
PaCO₂(mmHg, $x ¯$ ±s)	45.71±9.94	51.26±16.15	t=-3.621	0.035

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合并症	AECOPD组(42例)	COPD合并CAP组(59例)	χ²值	P值
脓毒血症[例(发生率,%)]	1(2.4)	3(5.1)	0.472	0.492
感染性休克[例(发生率,%)]	1(2.4)	4(6.8)	1.009	0.315
心力衰竭[例(发生率,%)]	5(11.9)	17(28.8)	1.719	0.042
慢性肾功能不全[例(发生率,%)]	0(0.0)	2(3.4)	1.452	0.228
肺大疱[例(发生率,%)]	12(28.6)	14(23.7)	0.080	0.778
肺心病[例(发生率,%)]	9(21.4)	18(30.5)	1.033	0.310
2型糖尿病[例(发生率,%)]	4(9.5)	6(10.2)	0.011	0.915
高血压病[例(发生率,%)]	9(21.4)	16(27.1)	0.426	0.514