肺功能异常对基层医院急性咳嗽患者病程及抗生素治疗反应的影响分析
2014/12/22
摘要
背景：通常认为急性咳嗽的患者的肺功能受损对慢性呼吸系统疾病（如哮喘、慢性阻塞性肺病）的病程具有消极影响，但是此观点缺乏明确的证据。
目的：本研究旨在研究肺功能异常对于急性咳嗽患者的病程以及初级医疗过程中对抗生素治疗反应的影响。
方法：总共3,104名急性咳嗽的患者（≤28天）纳入本项包含嵌套试验的前瞻性观察研究。其中2,427名患者在加入本试验的28～35天内进行了呼吸量测定。采用单变量及多变量回归模型分析肺功能异常如固定性阻塞（第1秒用力呼气量FEV1/最大肺活量FVC的比值小于0.7）以及支气管扩张剂反应性降低（在服用400ug舒喘灵后第1秒用力呼气量FEV1的增加量大于200ml或增加大于原来的12%）对于疾病症状的严重程度、持续时间以及恶化程度的影响。抗生素治疗被定义为在第一周内使用抗生素≥5天。通过交互作用来评估肺功能对抗生素治疗效果的修正效应。
结果：本项目的结果显示，只有严重气道受阻与患者第2～4天临床症状的严重程度显著相关（差异=0.31，95% 可信区间 CI=0.03-0.60， P=0.03）。肺功能障碍与患者抗生素治疗的有效性无关。在治疗之前使用吸入性皮质类固醇激素可导致30%中、重度患者临床症状的缓解时间延长（危害比=0.75，95%可信区间=0.63-0.90，P=0.00）。
结论：对于成年急性咳嗽患者，肺功能异常与疾病的病程无显著相关，其对抗生素的治疗效果也没有显著影响。
（刘国梁 审校）
NPJ Prim Care Respir Med. 2014 Sep 25;24:14067. doi: 10.1038/npjpcrm.2014.67.
Influence of lung function on course of disease and response to antibiotic therapy in adult primary care patients with acute cough: a post hoc analysis of patients enrolled in a prospective multicentre study.
van Erp N1, Little P2, Stuart B2, Moore M2, Thomas M2, Butler CC3, Hood K3, Coenen S4, Goossens H5, Leven M5, Verheij TJ1.
ABSTRACT
BACKGROUND: In acute cough patients, impaired lung function as present in chronic lung conditions like asthma and chronic obstructive pulmonary disease (COPD) are often thought to negatively influence course of disease, but clear evidence is lacking.
AIMS: To investigate the influence of lung function abnormalities on course of disease and response to antibiotic therapy in primary care patients with acute cough.
METHODS: A total of 3,104 patients with acute cough (≤28 days) were included in a prospective observational study with a within-nested trial, of which 2,427 underwent spirometry 28-35 days after inclusion. Influence of the lung function abnormalities fixed obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7) and bronchodilator responsiveness (FEV1 increase of ≥12% or 200 ml after 400 μg salbutamol) on symptom severity, duration and worsening were evaluated using uni- and multivariable regression models. Antibiotic use was defined as the reported use of antibiotics ≥5 days in the first week. Interaction terms were calculated to investigate modifying effects of lung function on antibiotic effect.
RESULTS: The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 (difference=0.31, 95% confidence interval (CI)=0.03-0.60, P=0.03). No evidence of a differential effect of lung function on the effect of antibiotics was found. Prior use of inhaled steroids was associated with a 30% slower resolution of symptoms rated 'moderately bad' or worse (hazard ratio=0.75, 95% CI=0.63-0.90, P=0.00).
CONCLUSIONS: In adult patients with acute cough, lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics.
NPJ Prim Care Respir Med. 2014 Sep 25;24:14067. doi: 10.1038/npjpcrm.2014.67.
