Page 38 - 2023-05-中国全科医学

2023年2月 第26卷 第5期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·551·

transmission since the outbreak of the pandemic. Several studies showed a decrease in hospitalizations for AECOPD during the
COVID-19 pandemic. However，there has been a relative lack of studies investigating the effects of preventive measures on
the frequency and severity of exacerbations. Objective To explore the impact of the COVID-19 pandemic on the frequency of
AECOPD with or without medical attention. Methods The subjects were from a prospective COPD cohort study conducted in
the First Affiliated Hospital of Guangzhou Medical University，which began recruiting patients in early 2016，with visits every 3
months to collect demographic and clinical data，including those who were followed up during June to August 2017（group 1），
June to August 2018（group 2），June to August 2019 （group 3），and June to August 2020（group 4）. Basic clinical data
（including the frequency of AECOPD，sex，age，symptom score and so on） were collected from group 1 from October 2016 to
May 2017，group 2 from October 2017 to May 2018，group 3 from October 2018 to May 2019，and group 4 from October 2019
to May 2020（during which the periods from October 2019 to January 2020，and from February to May 2020 were defined as pre-
COVID-19 period，and post-COVID-19 period，respectively）. The frequency of AECOPD during October to May next year
in group 4 was compared with that of the other three groups. The changes in the frequency of AECOPD between pre- and post-
COVID-19 periods were analyzed. Results There were 162 patients in group 1，157 in group 2，167 in group 3，and 159 in
group 4. Group 1 had a higher frequency of AECOPD in February to May than in October to January next year（P=0.013），
so did group 2（P=0.016）. In contrast，group 4 had a higher frequency of AECOPD in October to January next year than in
February to May（P=0.001）. The frequency of AECOPD during October to December in group 4 was similar to that of the other
three groups（P>0.05）. But the frequency of AECOPD from February to April in group 4 was lower than that in groups 1-3
（P<0.05）. There was no significant difference in the monthly frequency of AECOPD without medical attention in group 4
compared with that of groups 1-3（P>0.05）. The frequency of AECOPD with medical attention from October to December in group
4 was similar to that of groups 1-3（P>0.05）. but it from February to April in group 4 was lower than that in groups 1-3（P<0.05）.
Conclusion Prevention and control measures targeting COVID-19 may be contributive to reducing the frequency of AECOPD. It
is suggested that COPD patients should reduce gathering activities，maintain social distance，wear masks when going out，and
wash hands frequently even after the COVID-19.
【Key words】 Pulmonary disease，chronic obstructive；COVID-19；Acute exacerbation；Cohort studies；Follow-up

慢性阻塞性肺疾病（以下简称慢阻肺）是一种以持 台“口罩令”等一系列措施，以控制传染源、切断传播
续气流受限为特征、严重危害人类健康的常见病。慢阻 途径，减少病原体的传播。有研究将因 COVID-19 采取
肺急性加重是指患者以呼吸道症状加重为特征的临床事 公共卫生措施前后的流感活动指标与前 3 年的相应指标
件，其症状变化程度超出日常变异范围并导致药物治疗 进行比较发现，流感病毒阳性百分率明显下降，这表明
方案改变 ［1］ 。慢阻肺急性加重会降低患者的生命质量、 针对 COVID-19 采取的预防措施可有效减少病毒性呼吸
［2］
加速患者肺功能下降、增加患者经济负担及社会负担 ， 道疾病的传播 ［6］ 。防疫措施可减少人们之间的接触，
因此降低患者的急性加重频率意义重大。 进而减少了病毒性呼吸道疾病的传播，多项研究表明，
病毒感染是慢阻肺急性加重的重要诱因，其中鼻病 在 COVID-19 流行期间，因慢阻肺急性加重住院的频率
毒和普通冠状病毒是慢阻肺患者急性加重期间最常被检 有所下降 ［7-9］ ，但对包括未就诊和已就诊的慢阻肺急性
测到的病毒 ［3］ 。作为常见的慢性呼吸道疾病，慢阻肺 加重的影响缺乏研究。本研究拟探讨 COVID-19 疫情防
稳定期管理包括戒烟、规律药物治疗、接种流感疫苗和 控措施对慢阻肺急性加重频率的影响。
肺炎疫苗等 ［1］ ，但不包括戴口罩、保持社交距离等急 1 对象与方法
性呼吸道传染病的常见预防措施。 1.1 研究对象 本研究已通过广州医科大学附属第一
新型冠状病毒感染（COVID-19）同样由病毒感染 医院伦理委员会审批（2017-22）。研究对象来自广
引起，其人际传播途径包括接触感染者咳嗽和打喷嚏 州医科大学附属第一医院慢阻肺随访队列，该队列从
时产生的飞沫或接触受飞沫污染的表面（污染物）、 2016 年初开始招募患者，每 3 个月访视 1 次，收集人
吸入富含病毒的气溶胶以及通过口腔、鼻腔和眼黏膜 口学信息和临床资料。患者纳入标准：（1）年龄 40 岁
进行接触传播 ［4］ ，研究表明 6 英尺距离可以防止疾病 以上；（2）符合《慢性阻塞性肺疾病全球倡议（GOLD）》
传播 ［5］ 。COVID-19 疫情发生后，为防止病毒大范围 中的慢阻肺诊断标准 ［10］ ；（3）签署知情同意书，按
扩散，中国各地陆续启动重大突发公共卫生事件Ⅰ级 照研究方案进行随访。排除标准：（1）患有慢阻肺以
响应。根据 COVID-19 的传播特性，中国采取了居家隔 外的肺部疾病及严重 α1- 抗胰蛋白酶缺乏症；（2）接
离、应检尽检、限制公众聚集活动、保持社交距离、出 受过肺部手术，或近期诊断为恶性肿瘤；（3）正在参