Study On The Clinical Characteristics And High Risk Factors Of AECOPD Complicated With Lung Infection

BackgroundChronic Chronic obstructive pulmonary disease（COPD）ranks the third cause of death in the world^[1].COPD is considered to be an senile disease,with an incidence of17.5%in people≥60 years of age^[2].The latest forecasts of the World Health Organization on mortality and causes of death show that the prevalence of COPD will continue to rise in the next 40 years,and by 2060,more than 5.4 million people will die of COPD and related diseases every year^[3].Due to the recurrence of the disease,the pathogen spectrum and drug resistance of chronic obstructive pulmonary disease exacerbated（AECOPD）by certain changes^[4].This study analyzed the clinical characteristics and high-risk factors of AECOPD combined with lung infection,in order to provide guidance for clinical practice.ObjectiveTo explore the clinical characteristics and high-risk factors of AECOPD combined with pulmonary infection,in order to guide clinical practice.MethodsA collection of 206 patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）admitted to the First Affiliated Hospital of Xinxiang Medical College from June 2018 to June 2020.Refer to the diagnostic criteria for lung infection:Body temperature≥38℃,accompanied by symptoms such as coughing and coughing up purulent sputum,You can hear weakened breath sounds or dry and wet rales,A chest X-ray revealed an infection in the lungs,After laboratory examination,the peripheral blood white blood cell count>12×10⁹/L,immature（rod-shaped nucleus）neutrophils>10%,The results of 3sputum cultures suggested the presence of pathogenic bacteria,and the clinical decision was made to start or maintain antibiotic therapy.The included subjects were divided into groups according to whether they had pulmonary infection.In the infected group,148cases,including 114 cases with positive sputum culture,34 cases with negative sputum culture,58 cases in the non-infected group,112 males in the infected group,36 females,non-infected There were 43 males and 15 females in the group.Age≥40 years old.Retrospective analysis of the general conditions of the two groups of patients:gender,age,smoking history,body mass index,diabetes,respiratory failure,type and duration of antibacterial drugs,hospital stay,mechanical ventilation,long-term use of hormones,imaging features,blood routine（WBC,NE）,inflammation indicators（PCT,hs CRP,IL-6,ESR）;The results were analyzed statistically using SPSS 22.0 software,The count data is expressed as a rate（n,%）,conforming to a normal distribution,and a single factor analysis is performed using theχ² test.Does not conform to the normal distribution,using the quartile method for analysis;The measurement data is expressed as?x±s,and the compa-rison between the data groups in accordance with the normal distribution adopts the t test;Incorporate the statistically significant differences in univariate analysis into multivariate analysis,Multivariate binomial logistic regression model was used for multivariate analysis,Calculate the OR value,95%CI and P value,and P<0.05 as the difference is statistically significant.Results1.The hospitalization time and antibiotic application time in the infected group were significantly prolonged（P<0.05）,The difference was statistically significant.2.The positive rate of AECOPD sputum culture was 55.34%,The etiology of combined pulmonary infection is dominated by the distribution of bacteria,of which Gram-negative bacilli accounted for 47.37%.Gram-positive cocci accounted for 9.65%and fungi accounted for 42.98%.Pseudomonas aeruginosa is the most gram-negative bacilli,accounting for 15.79%.Streptococcus pneumoniae is the most common among Gram-positive cocci,accounting for 7.89%.Candida albicans is the most fungus,accounting for 34.21%.3.Comparison of the clinical characteristics of sputum culture-positive group and sputum culture-negative group in patients with AECOPD combined with lung infection,The difference was not statistically significant（P>0.05）.4.The main imaging features are emphysema,accounting for 75.7%;Patch exudation,consolidation,and inflammatory changes followed,accounting for 65.5%;Bullae accounted for 38.8%,Chronic bronchitis accounts for 11.6%,Pleural effusion accounted for 6.7%,Pneumothorax accounts for 3.8%,Interstitial lesions are the least,Accounted for2.9%.5.The blood routine（WBC,NE）expression level of the infected group was significantly higher than that of the non-infected group,and the difference was statistically significant（P<0.05）;The blood routine（WBC,NE）of the infection treatment group was significantly lower than that of the infection group,and the difference was statistically significant（P<0.05）.The expression levels of serum inflammatory factors PCT,hs CRP,IL-6 and ESR in the infected group were significantly higher than those in the non-infected group,and the difference was statistically significant（P<0.05）;Serum inflammatory factors in the infection treatment group were significantly lower than those in the infection group,and the difference was statistically significant（P<0.05）.6.The results of single factor analysis of diabetes,respiratory failure,mechanical ventilation,antibiotic application and long-term hormone application were again incorporated into the multivariate binomial Logistic regression model for risk analysis.Respiratory failure,application of mechanical ventilation,application of antibiotics≥2,long-term use of hormones and other factors are all high-risk factors for AECOPD complicated with lung infection（P<0.05）.Conclusions1.Patients with AECOPD complicated with pulmonary infection have prolonged hospitalization time and antibiotic application time,higher blood routine and inflammatory index changes,and more obvious chest CT inflammatory changes;2.Respiratory failure,application of mechanical ventilation,application of antibiotics≥2,long-term use of hormones and other factors are high risk factors for AECOPD complicated with lung infection.