Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant bacteria
Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant bacteria
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DOI：
10.1136/thx.2006.061366
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发表时间：
2006-11-01
期刊：
影响因子：
10
通讯作者：
Aaron, S. D.
中科院分区：
文献类型：
--
作者：
Block, J. K.;Vandemheen, K. L.;Aaron, S. D.
背景资料：本研究探讨了囊性纤维化（CF）的成人和青少年患者的特点，以确定与肺恶化的风险增加的相关因素。方法：招募了249例感染多药耐药菌的CF患者，并前瞻性随访长达4.5年，直到他们经历了肺恶化严重到需要静脉注射抗生素。多变量回归分析被用来比较谁经历了恶化与那些谁没有。结果：124 249例（50%）开发了肺恶化在第一年和154（62%）经历了恶化在4.5年的研究期间的患者的特点。在多变量生存模型中预测急性加重的因素是年轻（OR 0.98，95% CI 0.96 - 0.99），女性（OR 1.45，95% CI 1.07 - 1.95），1秒用力呼气量（FEV 1）降低（OR 0.98，95% CI 0.97 - 0.99）和既往多次肺部急性加重史（OR 3.16，95% CI 1.93 - 5.17）。慢性使用吸入性皮质类固醇与加重的风险增加（OR 1.92，95%CI 1.00至3.71）在第一个研究year.Conclusions：患者谁的经验，肺部急性加重更可能是年轻，女性，使用吸入性类固醇，有较低的FEV 1，和历史上的多个以前的急性加重。希望了解这些风险因素将有助于更好地识别和密切监测急性加重高风险患者。
Background: This study examined characteristics of adult and adolescent patients with cystic fibrosis ( CF) to determine factors associated with an increased risk of pulmonary exacerbations.Methods: 249 patients with CF infected with multidrug resistant bacteria were recruited and prospectively followed for up to 4.5 years until they experienced a pulmonary exacerbation severe enough to require intravenous antibiotics. Multivariable regression analyses were used to compare the characteristics of patients who experienced an exacerbation with those who did not.Results: 124 of the 249 patients ( 50%) developed a pulmonary exacerbation during the first year and 154 ( 62%) experienced an exacerbation during the 4.5 year study period. Factors predictive of exacerbations in a multivariable survival model were younger age ( OR 0.98, 95% CI 0.96 to 0.99), female sex ( OR 1.45, 95% CI 1.07 to 1.95), lower forced expiratory volume in 1 second ( FEV1) ( OR 0.98, 95% CI 0.97 to 0.99), and a previous history of multiple pulmonary exacerbations ( OR 3.16, 95% CI 1.93 to 5.17). Chronic use of inhaled corticosteroids was associated with an increased risk of exacerbation ( OR 1.92, 95% CI 1.00 to 3.71) during the first study year.Conclusions: Patients who experience pulmonary exacerbations are more likely to be younger, female, using inhaled steroids, have a lower FEV1, and a history of multiple previous exacerbations. It is hoped that knowledge of these risk factors will allow better identification and closer monitoring of patients who are at high risk of exacerbations.