Objective: To study the clinical and etiological characteristics of viral pneumonia in patients with chronic obstructive pulmonary disease(VP-COPD), and to identify the risk factors associated with poor prognosis. Methods: From August 1, 2017 to August 1, 2019, totally 235 patients in a general hospital in Beijing were prospectively enrolled in this research, and all patients were diagnosed with viral pneumonia by imaging and etiology. The patients were divided into VP-COPD group(n=60) and VP-nCOPD(viral pneumonia in non-COPD patients) group(n=175). Pathogen detection and clinical characteristics were compared between the two groups.Finally, the binomial logistic regression was used to explore the risk factors associated with severe VP-COPD. Results: Compared with the VP-nCOPD group, the VP-COPD group was older(76.5 vs 66.0 years, P=0.001), and the CURB-65 score(2 vs 1, P= 0.001) and the PSI score(111 vs 85, P<0.001) were higher at admission. Pseudomonas aeruginosa(χ²= 10.308, P= 0.001) and Staphylococcus aureus(χ²= 5.953, P=0.028) were the most common co-infection bacteria. In the VP-COPD group type Ⅱ respiratory failure was more common(23.3% vs 6.8%, P<0.001), the number of severely ill patients was larger(48.3% vs 30.3%, P=0.011), the length of hospital stay was longer(13 vs 8, P<0.001), and the mortality rate during hospitalization was higher(18.3% vs 7.4%, P=0.016) in the VP-nCOPD group. Multivariate analysis showed that the level of blood glucose(OR: 1.73, 95%CI: 1.22-2.44, P= 0.002) and pleural effusion(OR: 133.12, 95%CI: 7.57-2 340.36, P=0.001) were risk factors for severe VP-COPD patients. Conclusion: Viral pneumonia in patients with COPD tended to develop into severe cases and had a poor prognosis.
目的： 观察合并慢性阻塞性肺疾病（简称慢阻肺）的病毒性肺炎（VP-COPD）患者的临床特征及病原学特点，探讨不良预后相关的风险因素。 方法： 前瞻性纳入2017年8月1日至2019年8月1日在北京同仁医院确诊的235例成人病毒性肺炎住院患者，根据是否合并慢阻肺分为VP-COPD组和未合并慢阻肺的病毒性肺炎组（VP-nCOPD组）。VP-COPD组60例，其中男49例，女11例，中位年龄76.5岁；VP-nCOPD组175例，男93例，女82例，中位年龄66.0岁。对两组患者进行病原体检测并比较临床特征，通过二项logistic回归探索重症VP-COPD的风险因素。 结果： VP-COPD组与VP-nCOPD组比较，年龄（76.5岁比66.0岁，P=0.001）、入院时CURB-65评分（2分比1分， P=0.001）和PSI评分（111 分比85分， P<0.001）差异均有统计学意义。VP-COPD组更易合并铜绿假单胞菌（χ²=10.308，P=0.001）及金黄色葡萄球菌（χ²=5.953，P=0.028）感染，Ⅱ型呼吸衰竭更常见（23.3%比6.8%，P<0.001），重症患者比例高（48.3%比30.3%，P=0.011），住院时间更长（13 d比8 d，P<0.001），院内病死率高（18.3%比7.4%，P=0.016）。多因素分析结果表明高血糖（OR值为1.73，95%CI：1.22~2.44，P=0.002）与胸腔积液（OR值为133.12，95%CI：7.57~2 340.36，P=0.001）是VP-COPD患者发展为重症的风险因素。 结论： 存在慢阻肺基础疾病的病毒性肺炎患者易发展为重症，预后不良，临床应予以重视。.