目的:探讨影响慢性阻塞性肺疾病急性加重（AECOPD）合并二氧化碳（COn 2）潴留患者应用全身糖皮质激素的相关因素，指导制定减少全身糖皮质激素暴露的策略。n 方法:选择2017年1月至2019年12月福建医科大学附属宁德市医院收治的AECOPD合并COn 2潴留患者作为研究对象。收集患者一般资料、既往史、1年内急性加重次数，入院时有无肺炎、诱发COPD原因、是否合并心力衰竭、血气分析及血清嗜酸粒细胞计数（EOS）、白蛋白（Alb）和载脂蛋白E（ApoE）水平，以及急性加重期呼出气一氧化氮（FeNO）水平、接受雾化吸入糖皮质激素和无创机械通气治疗情况。根据住院期间患者累计全身糖皮质激素暴露情况分为推荐剂量组（暴露水平在推荐剂量范围内，泼尼松累计剂量≤200 mg）和超量组（暴露水平超过推荐剂量，泼尼松累计剂量>200 mg）。比较两组患者的临床资料，并将单因素分析中n P 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with n P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO n 2 retention.n Results:According to the order of hospitalization, 151 AECOPD patients with COn 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaOn 2/FiOn 2), arterial partial pressure of carbon dioxide (PaCOn 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with COn 2 retention were FEV1% at stable phase [odds ratio (n OR) = 0.957, 95% confidence interval (95%n CI) was 0.921-0.994, n P = 0.023], acute exacerbation frequency within 1 year (n OR = 1.530, 95%n CI was 1.121-2.088, n P = 0.007), heart failure (n OR = 3.022, 95%n CI was 1.263-7.231, n P = 0.013), PaCOn 2 (n OR = 1.062, 95%n CI was 1.010-1.115, n P = 0.018) and EOS at admission (n OR = 0.103, 95%n CI was 0.016-0.684, n P = 0.019), aerosolized inhaled glucocorticoids (n OR = 0.337, 95%n CI was 0.145-0.783, n P = 0.011) and non-invasive mechanical ventilation at acute exacerbation (n OR = 0.422, 95%n CI was 0.188-0.948, n P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCOn 2 were risk factors.n Conclusions:For AECOPD patients with COn 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCOn 2 can increase systemic glucocorticoid exposure.n