Analysis of the factors influencing the efficacy of conventional Western medicine treatment on patients with acute exacerbation of COPD
Objective To explore the factors influencing the efficacy of conventional Western medicine treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide a basis for individualized clinical treatment.Methods 100 patients with AECOPD were prospectively included in this study,and all of them were given standard treatment plans according to the guidelines.After 3 months of follow-up observation,53 cases were evaluated as effective and included in the effective group;47 cases were evaluated as having no significant effect and included in the ineffective group.Differences in basic characteristics between the two groups in terms of age,duration of COPD,respiratory rate,lung function and consolidated malignancy were compared,and pre-treatment laboratory test indexes and blood gas analysis data were collected for comparison.Results There were significant differences between the two groups in terms of age,duration of COPD,respiratory rate,ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC%),consolidated malignancy,hemoglobin,lymphocytes,C-reactive protein,glutamic-pyruvic transaminase and PaCO2(P<0.05).Univariate logistic regression analysis showed that older age,prolonged COPD duration,increased respiratory rate,decreased FEV1/FVC%,consolidated malignancy,decreased hemoglobin,decreased lymphocyte count,increased C-reactive protein,increased glutamic-pyruvic transaminase,increased lactate,and increased PaCO2 were risk factors for poor treatment outcome in AECOPD.Further multifactorial logistic regression analysis showed that age(P=0.007,OR=1.240),FEV1/FVC%(P=0.014,OR=0.757),hemoglobin(P=0.038,OR=0.954),lymphocyte count(P=0.007,OR=0.488),and lactate(P=0.002 OR=9.964)were independent risk factors affecting the efficacy of AECOPD treatment.ROC curve analysis showed that the AUCs for age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate were 0.728[95%CI(0.627,0.829)],0.681[95%CI(0.576,0.785)],0.686[95%CI(0.582,0.790)],0.629[95%CI(0.520,0.737)]and 0.823[95%CI(0.744,0.902)],respectively,and the combined AUC of the five risk factors for predicting a poor AECOPD treatment outcome was 0.957[95%CI(0.923,0.991).Conclusion Age,FEV1/FVC%,hemoglobin,lymphocyte count and lactate are independent risk factors that influence the treatment outcome of AECOPD patients.The comprehensive analysis of these risk factors can predict the treatment effect of AECOPD more accurately,help clinicians adjust the treatment plan in time,and improve the treatment effect and prognosis.
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