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目的:探讨体质指数(BMI)与慢性阻塞性肺疾病急性加重期(AECOPD)病人临床结局的关系。方法:计算177例AECOPD病人的BMI,并进行不同BMI组间AECOPD病人血气指标分析、BMI与机械通气关系分析、BMI与病情转归关系分析和BMI与住院时间(LOS)的相关性分析。结果:低BMI组(BMI<18.5)、正常BMI组(BMI 18.5~23.9)以及高BMI组(BMI>24.0)组间病人PCO2值和PO2/PCO2值均有显著性差异(P=0.032,P=0.024)。多重比较显示,低BMI组病人的PCO2值较正常BMI组高(P=0.020),而PO2/PCO2值和pH值低于正常BMI组(P=0.013,P=0.027)。低BMI组病人实施机械通气的概率比(OR)为正常BMI组的6.015倍。采用年龄分层卡方检验显示,低BMI组中年龄≥70岁的病人死亡OR为正常BMI组的4.06倍,<70岁病人死亡率未显示BMI与死亡率之间的相关性。排除年龄因素,BMI与LOS呈负相关关系(r=-0.165,P=0.038)。结论:低BMI可能导致AECOPD病人机械通气概率增高、住院时间延长、病死率升高等不良临床结局。
Objective: To investigate the relationship between body mass index (BMI) and clinical outcome in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: The BMI of 177 patients with AECOPD were calculated. The blood gas indexes of AECOPD patients, the relationship between BMI and mechanical ventilation, the relationship between BMI and the disease and the relationship between BMI and hospital stay (LOS) were analyzed. Results: There were significant differences in PCO2 and PO2 / PCO2 between low BMI group (BMI <18.5), normal BMI group (18.5-23.9) and high BMI group (BMI> 24.0) = 0.024). Multiple comparisons showed that PCO2 values in patients with low BMI were higher than those in patients with normal BMI (P = 0.020), while PO2 / PCO2 values and pH values were lower than those in patients with normal BMI (P = 0.013, P = 0.027). The odds ratio (OR) of mechanical ventilation in patients with low BMI was 6.015 times that of the normal BMI group. By age-stratified chi-square test, the OR of death in patients with age≥70 years in low BMI group was 4.06 times of that in normal BMI group. The mortality of patients <70 years old did not show the correlation between BMI and mortality. Excluding the age factors, BMI and LOS was negatively correlated (r = -0.165, P = 0.038). Conclusions: Low BMI may lead to poor clinical outcome in AECOPD patients with increased probability of mechanical ventilation, prolonged hospital stay, and increased mortality.