Analysis Of Prognostic Factors In Patients With Chronic Obstructive Pulmonary Disease At Long-term Follow-up

ObjectiveIn this study,patients with chronic obstructive pulmonary disease?COPD?who were treated at the Department of Respiratory Clinic of Guangdong Provincial Hospital during the past 10 years?2007-2017?were selected as subjects to study the prognosis under long-term intervention of traditional Chinese medicine and integrated traditional Chinese and Western medicine.THe objective is to analyze and discuss the factors that affect the prognosis and provide reference for the development of clinical diagnosis and treatment protocols.MethodsRetrospective surveys and on-site follow-ups were performed on COPD patients who had been attended the outpatient department of the Department of Respiratory Medicine of the Guangdong Provincial Hospital during the period2007-2017,using retrospective and clinical follow-up studies to collect the patient's age,gender,and smoking history,history of smoking cessation,occupational exposure history,history of basic pulmonary disease,history of other extrapulmonary diseases,family history,history of physical exercise,oxygen therapy,treatment,comorbidities,first and last lung function test results,acute exacerbations,last CAT Scores,blood gas analysis results and other information,and then using SPSS 17.0 statistical software to establish a database,group observation indicators and influencing factors,select variance analysis,choose 2 test or rank sum test or univariate analysis,later use unconditional stepwise logistic regression.Results1.A total of 114 cases of COPD were collected in this study,including94 males and 20 females,aged 43-96 years and 90.1%over 60 years old.Duration of disease is between 2-21 years,83 patients has a history of COPD more than5 years.Follow-up duration was between 1-13 years,and 60.6%were over 5 years;59 of them had intact pulmonary function before and after,with initial pulmonary function results.There were 73 cases,70 cases with the last result of lung function.2.In COPD patients,the FEV₁ values of different GOLD groups showed different year-on-year decline rates.This study screened 59 cases of pre and post pulmonary function.The group's calculations showed that the fall rate of FEV₁ was:GOLD II group:57.75±70.74 ml/yr,GOLD III grade group:28.46±46.66ml/yr,Gold IV grade group:10.25±24.43ml/yr.3.The univariate analysis of the annual decline rate of FEV₁ in 59 patients?slower group:<30 ml/yr,faster group:?30 ml/yr?suggested that the decline rate of FEV₁ was statistically significant among the initial FEV₁ group?P<0.05?.The non-conditional stepwise logistic regression analysis suggested that the risk of a rapid decrease in FEV₁ was 5.60 times more than patients with FEV₁>1.0L at the early stage of disease?P<0.05?,OR=5.60,and OR95%CI was?1.756,17.855?,and the initial FEV₁ value is positively correlated with the rate of decline in FEV₁.4.The univariate analysis was performed on the 114 patients with acute exacerbations in last year?less frequent:?1,more frequent:?2?.The results suggested that:the smoking index,whether there is physical activity after the onset,whether there is oxygen therapy,whether there is pulmonary heart disease,CAT score were statistically significant among the number of acute exacerbations in the past year?P<0.05?.Non-conditional stepwise logistic regression analysis suggested that in COPD patients with higher smoking index,the risk of more acute exacerbations was 4.116 times higher than those with lower smoking index,and OR=4.516,OR95%CI?1.129,15.301?.In COPD patients with physical exercise,the risk of more acute exacerbations was 6.631 times higher than those without physical exercise,and OR=6.631,OR95%of CI?1.943 32.63 33?.In COPD patients with oxygen therapy,the risk of more acute exacerbations was 3.631 times higher than those without oxygen therapy,and OR=3.631,OR 95%of CI?1.020,12.928?.5.The univariate analysis was performed on 114 CAT scores?less symptoms:<10 points,more symptoms:?10 points?in 114 patients.The results suggested whether or not with chronic bronchitis,whether or not receiving oxygen therapy,frequency of acute exacerbations in the past year,frequency of acute exacerbations needing hospitalizations in the past year,the presence of respiratory failure,and the presence or absence of combined pulmonary bulla were significantly different in the CAT score group?P<0.05?.Unconditional stepwise logistic regression analysis suggested that the risk of high CAT scores in COPD patients was 4.877 times higher in those with more frequency of acute exacerbations,and OR=4.877,OR 95%CI?1.123,21.177?.The risk of higher CAT score was 8.742 times higher in those with chronic bronchitis in the past,and OR=8.742,OR95%of CI?1.871,40.854?.The risk of higher CAT score was 9.727 times higher in those with pulmonary bulla,and OR=9.727,OR 95%of CI?1.034,91.496?.6.In 70 cases with the last lung function during the 2016-2017 period,the final CAT scores?less symptoms:<10 points,more symptoms:?10 points?were grouped,and the final FEV₁ value and FEV₁%grading were analyzed.There was no significant difference in the final FEV₁ and FEV1%grades in the CAT scores?P>0.05?.7.73 cases of COPD patients with initial lung function were grouped according to the initial FEV₁?Group 1:?1.0L,Group 2:>1.0L?as exposure factors and analyzed with the recent CAT score,the frequency of acute exacerbations in last year,the frequency of hospitalizations due to acute exacerbation and respiratory failure.The result showed that CAT scores were statistically significant between the initial FEV1 values?P<0.05?.In patients with initial FEV₁?1.0L,the risk of high CAT scores in the near future was 3.385 times higher than patients with initial FEV₁>1.0L,and 95%of the CIs were?1.091,10.505?.the frequency of acute exacerbations in the past year was statistically significant between the initial FEV₁ values?P<0.05?,in patients with initial FEV₁?1.0L,the risk of more acute exacerbations in the past year was 3.800 times more than the patients with initial FEV₁>1.0L,and 95%of the CIs were?1.296,11.144?.There was no significant difference in the frequency of hospitalizations due to acute exacerbations in last year and whether there was a combination of respiratory failure?P>0.05?.8.All of the 114 patients were presented with the lung qi deficiency?n=8?,lung and spleen qi deficiency?n=39?,lung and kidney qi deficiency?n=55?,lung and kidney qi and yin deficiency?n=12?.61 cases were mixed with physical constitutions:lung qi deficiency with turbidity?n=7?,lung qi deficiency with turbidity and heat?n=3?,lung qi deficiency with turbidity and blood stasis?n=29?,and lung qi deficiency with blood stasis?n=22?.9.114 patients were divided into 4 groups according to the qi deficiency type?Qi deficiency syndrome,lung and spleen qi deficiency syndrome,lung and kidney qi deficiency syndrome,lung and kidney qi deficiency syndrome?for single factor analysis,the results suggest:age,duration and frequecy of hospitalization due to acute exacerbation in last year were statistically significant in these four groups?P<0.05?.In terms of age,60-79-year-olds and 80-year-olds have the highest incidence of lung-kidney qi deficiency,followed by lung and spleen deficiency.In terms of disease course,the patients with lung and spleen deficiency syndrome and lung-kidney qi deficiency syndrome were mostly present in patients aged<5 years or?5 years,and the proportion of lung-kidney qi deficiency was relatively higher in patients aged?5 years.Patients with acute aggravated hospitalization in the past year were mainly those with qi deficiency of both lung and kidney.Patients with no acute exacerbations in the past year were mainly those with qi deficiency of lung and spleen.10.The univariate analysis was performed on 61 cases of patients with syndromes of deficiency and miscellaneous,and 61 patients were divided into four groups?lung qi deficiency with turbidity,lung qi deficiency with turbidity and heat,lung qi deficiency with turbidity and blood stasis,and lung qi deficiency with blood stasis?.The results suggested that:there was a statistically significant difference in the classification of inclusion syndromes?P<0.05?.In 60-79 year-old patients the lung qi deficiency with turbidity and blood stasis differentiation was more often while lung qi deficiency with blood stasis differentiation was more usual in patients over80 years old.11.The 61 patients were divided into 2 groups according to whether there was turbidity in body or not.The turbidity was used as the exposure factor.The CAT score,the number of acute exacerbations in the past year,and the frequency of acute exacerbations in last year were taken as the prognosis.The variables were analyzed and the results suggested that the frequency of hospitalizations due to acute exacerbations in last year was statistically significant in the presence of turbidity group?P<0.05?.The risk of more frequent was 3.213 times higher in patients with turbidity than those without turbidity,OR=3.213,and 95%of CI was?1.306,7.907?.12.The 61 patients were divided into 2 groups according to whether there was blood stasis in body or not.The blood stasis was used as the exposure factor.The CAT score,the number of acute exacerbations in the past year,and the frequency of acute exacerbations in last year were taken as the prognosis.The variables were analyzed and the results suggested that the frequency of hospitalizations due to acute exacerbations in last year was statistically significant in the presence of turbidity group?P<0.05?.The variables were analyzed and the results suggested that the frequency of acute exacerbations in last year and the frequency of hospitalizations due to acute exacerbations in last year were statistically significant in the presence of turbidity group?P<0.05?.The risk of more frequency of acute exacerbation was 2.240 times higher in patients with blood stasis than those without blood stasis,OR=2.240,and 95%of CI was?1.002,5.007?.The risk of more hospitalization frequency due to acute exacerbation was 2.493 times higher in patients with blood stasis than those without blood stasis,OR=2.493,and95%of CI was?1.119,5.556?.Conclusion1.In patients with COPD,the FEV1 values of different GOLD classifications showed different rates of decline,showing rapid decline at first and then slow rates.Among them,GOLD II grade had the fastest decline rate,followed by grade III and lowest grade IV.The rate of decline is related to the initial FEV₁ value.It is advisable to perform early pulmonary function teat to reduce missed diagnosis and give early intervention.2.The frequency of acute exacerbations of COPD patients in last year was related to the smoking index,physical exercise after the onset,and oxygen therapy.COPD patients should quit smoking as soon as possible to reduce the frequency of acute exacerbations,and higher risks in physical exercise and oxygen therapy indicated the result of treatment interventions rather than inducing factors.3.The CAT scores in patients with COPD were related to previous chronic bronchitis,frequency of acute exacerbations in last year,and presence of pulmonary bulla.Preventing the progression of chronic bronchitis to COPD,reducing the number of acute exacerbations as well as preventing the occurrence and progression of bullae,will possibly help to reduce the CAT score and improve the patients'quality of life.4.With the extension of age and duration of illness,deficiency of lung and spleen qi as well as deficiency of lung and spleen qi were more often to be seen.The presence of turbidity and blood atasis may be the possible cause of more acute exacerbations.Removing the turbidity and blood stasis during remission of disease may reduce the inducing factors and improve prognosis.