内科

目的比较慢性阻塞性肺病急性加重期(AECOPD)与慢性阻塞性肺病(COPD)合并社区获得性肺炎(CAP)患者的临床表现，提高诊治水平。方法选取我院呼吸内科2016年3月至2017年3月收治并确诊为COPD的患者720例作为研究对象，根据病史及胸部CT检查结果分为AECOPD组和COPD合并CAP组。比较两组患者的临床症状、炎症指标水平、血气分析结果、肺功能检测结果、治疗结果和并发症的发生情况。结果COPD合并CAP组患者出现咳脓痰、呼吸困难、发热、神志淡漠、精神差的比例显著高于AECOPD组患者（P＜0.05）。两组患者的WBC、N（%）、CRP、PCT水平均高于正常值，COPD合并CAP组患者上述指标的水平高于AECOPD组患者(P＜0.05)。COPD合并CAP组患者出现低氧血症的比例显著高于AECOPD组患者(P＜0.05)。两组患者的肺功能均异常降低，COPD合并CAP组患者的FVC、FEV1/FVC、FEV1%、PEFR水平均显著低于AECOPD组(P＜0.05)。COPD合并CAP组患者治疗有效的比例显著低于AECOPD组(P＜0.05)，症状加重的比例以及住院期间病死率显著高于AECOPD组(P＜0.05)。COPD合并CAP组患者呼吸衰竭、心力衰竭、电解质紊乱、多脏器衰竭、消化道出血的发生率显著高于AECOPD组(P＜0.05)。结论COPD合并CAP与AECOPD患者症状相似，但二者的炎症指标水平，肺功能改变程度，低氧血症、并发症的发生情况以及治疗结果存在较大的差异，对患者进行相关的临床检测，认真分析病情，有助于正确诊断和鉴别诊断，提高临床治疗效果。

ObjectiveTo compare the clinical manifestations of chronic obstructive pulmonary disease (AECOPD) and chronic obstructive pulmonary disease (COPD) with community-acquired pneumonia (CAP), and to improve the diagnosis and treatment level. Methods720 patients who were admitted and diagnosed as COPD from March 2016 to March 2017 in the Department of respiratory medicine of our hospital, who were divided into AECOPD group and COPD combined with CAP group according to the medical history and the results of chest CT examination. The clinical symptoms, the level of inflammation, the results of blood gas analysis, the results of lung function test, the result of treatment and the occurrence of complications were compared between the two groups. ResultsCough purulent sputum, dyspnea, fever, poor mental haziness of the COPD combined with CAP group higher than the AECOPD group (P＜0.05) . The levels of WBC, N%, CRP and PCT in the two groups were all higher than those of the normal values. The level of the above index in the COPD combined with CAP group was higher than that in the AECOPD group(P＜0.05). The proportion of hypoxemia in the COPD combined with CAP group was higher than that in the AECOPD group (P＜0.05). The lung function of the two groups were all abnormally decreased, and the levels of FVC, FEV1/FVC, FEV1% and PEFR in the COPD combined with CAP group were lower than those in the AECOPD group (P＜0.05). The effective proportion of the COPD combined with CAP group was lower than that in the AECOPD group(P＜0.05). The proportion of the symptom aggravation and the mortality rate during hospitalization were higher than those in the AECOPD group (P＜0.05). The incidence of respiratory failure, heart failure, electrolyte disturbance, multiple organ failure and gastrointestinal bleeding in the COPD combined with CAP group was higher than that in the AECOPD group (P＜0.05). ConclusionThe symptoms of COPD combined with CAP are similar to those of AECOPD. But there were significant differences in the level of inflammation, the degree of pulmonary function change, hypoxemia, the occurrence of complications and the outcome of the treatment of the two. Related clinical tests for patients is helpful to correct diagnosis and differential diagnosis and improve the effect of clinical treatment.