住院AECOPD患者临床特点及其与季节性变化的气象因素的相关性研究

摘要

目的 探讨住院慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床特点及其与季节性变化的气象因素的关系.为临床上探索预防AECOPD反复发作的措施及进行有针对性的宣教提供指导.方法 回顾2010年1月-2013年6月在首都医科大学附属北京世纪坛医院住院的AECOPD患者921例,其中符合纳入标准的736例.同期北京当地气象因素资料来自中国气象科学数据共享服务网中的中国地面国际交互站气候资料月数据集,包括温差、气温、气压、湿度、风速、日照时间,其与气象因素的相关性采用直线相关分析.结果 736例住院AECOPD患者,病情分组以D组为主(597例,81.1%);痰培养阳性225例(30.6%),其中细菌培养阳性188例,真菌培养阳性82例,两者均阳性45例.共检出病原菌651株,其中细菌549株(84.3%)(革兰阴性菌483株,革兰阳性菌66株),真菌102株(15.7%).细菌培养阳性率与温差、气压呈负相关(r=-0.662,P=0.019;r=-0.596,P=0.041),与湿度呈正相关(r=0.600,P=0.039).糖皮质激素应用率与日照时间呈负相关(r=-0.687,P=0.014).结论 住院AECOPD患者的某些临床特点与季节性变化的温差、气压、湿度及日照时间存在相关性.%Objective To explore the clinical characteristics of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and the relationship between them and the meteorological factors of seasonal variation.To provide a guidance for the clinical exploration of measures to prevent the recurrence of AECOPD and and targeted education.Methods A total of 921 patients with AECOPD hospitalized in Beijing Shijitan Hospital,CMU from January 2010 to June 2013 were reviewed.Among them,736 patients met the inclusive criteria.The local meteorological data during the same period in Beijing were collected from the monthly data set of China ground interactive station in China Meteorological Science Data Sharing Service network,including temperature difference,temperature,air pressure,humidity,wind speed and sunshine duration,and the correlation between them and meteorological factors was analyzed by linear correlation analysis.Results Among the 736 cases with AECOPD,the grade of disease was mainly group D(597 cases,81.1%).Sputum culture was positive in 225 cases(30.6%),188 cases were positive for bacterial culture,82 cases were positive for fungal culture,and both were positive in 45 cases.A total of 651 strains of pathogenic bacteria were detected,including 549 bacteria(84.3%)(483 gram negative bacteria,66 gram positive bacteria),and 102 fungal strains(15.7%).The positive rate of bacteria was negatively correlated with temperature difference and air pressure(r=-0.662,P=0.019;r=-0.596,P=0.041),and positively correlated with humidity(r=0.600,P=0.039).The rate of glucocorticoids application was negatively correlated with the sunshine duration(r=-0.687,P=0.014).Conclusion Some of the clinical characteristics of hospitalized AECOPD patients are closely related to the meteorological factors of seasonal variation,such as temperature difference,air pressure,humidity,and sunshine duration.