合并症降低了伴有严重肺过度充气的慢性阻塞性肺疾病患者的生存率和生活质量

Else-Anna-Maria-Dorothee ter Haar, D. Slebos, K. Klooster, S. D. Pouwels, J. Hartman
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摘要

慢性阻塞性肺病(COPD)患者通常伴有大量合并症,这被认为与较高的死亡风险有关。我们的目的是调查合并症的患病率及其对生存和生活质量(QoL)的影响,尤其是以严重肺过度充气为特征的肺气肿患者的合并症。合并症由患者通过问卷报告,并与患者的医疗记录进行验证。我们纳入了 830 名 GOLD III 期和 IV 期慢性阻塞性肺病患者。与无合并症的患者相比,合并症患者的 QoL 明显较差(均 p<0.05)。我们的研究结果表明,合并症与以严重过度充气为特征的肺气肿患者较低的生存率和较差的 QoL 相关。对焦虑、低体重指数和肺动脉高压等可治疗特征进行适当治疗,可使这一特殊患者群体的生存率提高,生活质量改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comorbidities reduce survival and quality of life in COPD with severe lung hyperinflation
Patients with chronic obstructive pulmonary disease (COPD) often present with a significant number of comorbidities, which are thought to be related to a higher mortality risk. Our aim was to investigate the prevalence and impact of comorbidities on survival and quality of life (QoL), specifically in patients with emphysema characterized by severe lung hyperinflation.Data were prospectively collected from patients, who visited our hospital for evaluating their eligibility for a bronchoscopic lung volume reduction treatment, and were included in the Groningen Severe COPD cohort (NCT04023409). Comorbidities were patient-reported by a questionnaire, and were validated with patients’ medical records. QoL was assessed with the St. Georges Respiratory Questionnaire (SGRQ).We included 830 COPD patients with GOLD stage III and IV. The total number of comorbidities was an independent predictor of survival when adjusting for other factors influencing survival (HR 1.12, 95%CI:1.05–1.20, p<0.001). Of the individual comorbidities, pulmonary arterial hypertension (HR 1.53, 95%CI:1.01–2.32, p=0.045), low body-mass index (HR 1.63, 95%CI:1.16–2.27, p=0.004), and anxiety (HR 1.46, 95%CI:1.11–1.92, p=0.007) were independently associated with worse survival. Moreover, patients having 3, 4 or >5 comorbidities had a significantly (all p<0.05) worse QoL, in comparison to patients without comorbidities.Our results show that comorbidities were associated with lower survival and poor QoL in emphysema patients characterized by severe hyperinflation. Appropriate treatment of treatable traits, including anxiety, low body-mass index, and pulmonary arterial hypertension, could lead to a survival benefit and improvement in QoL in this specific patient population.
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