摘要目的:探讨影响慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者短期预后的危险因素。方法:本研究为病例对照研究。采用非随机抽样法，收集2015年1月至2021年12月首都医科大学附属北京朝阳医院呼吸与危重症医学科第一诊断为AECOPD且合并呼吸衰竭的住院患者，根据入院28 d预后情况分为死亡组及存活组。比较2组实验室指标、无创呼吸机使用情况、住院天数。采用多因素logistic回归分析影响AECOPD合并呼吸衰竭患者短期预后的危险因素，采用受试者工作特征曲线评价相关危险因素对入院28 d死亡的预测价值。结果:共纳入291例AECOPD合并呼吸衰竭患者，其中死亡组29例(10.0%)，存活组262例(90.0%)。死亡组血小板平均体积(MPV)、中性粒细胞与淋巴细胞比值(NLR)、动脉血二氧化碳分压(PaCO 2)、纤维蛋白原(FIB)、无创呼吸机使用率、无创呼吸机失败率均高于存活组( P值均<0.05)，淋巴细胞计数、动脉血酸碱度(pH)均低于存活组( P值均<0.05)。多因素logistic回归分析显示MPV( OR＝1.83，95% CI：1.20~2.78， P＝0.005)、PaCO 2( OR＝1.04，95% CI：1.02~1.06， P＝0.001)是入院28 d死亡的独立危险因素。两项指标联合预测入院28 d死亡的敏感度为82.8%，特异度为63.4%(曲线下面积0.79，95% CI：0.72~0.87， P<0.001)。 结论:MPV、PaCO 2是AECOPD合并呼吸衰竭患者短期死亡的独立危险因素，两项指标联合预测其预后不良具有较好临床价值。

abstractsObjective:To investigate the risk factors of short-term prognosis in patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:This was a case-control study.Non-random sampling method was used to select 291 patients with respiratory failure due to AECOPD admitted to Beijing Chao-Yang Hospital, affiliated to Capital Medical University, Department of Respiratory and Critical Care Medicine from January 2015 to December 2021.The patients selected were classified into death and survival groups according to with or without death of 28 days after admission.The laboratory index on admission, the use of non-invasive ventilation, and length of hospital stay between two groups were compared.Multivariate logistic regression was used to analyze the risk factors for 28 days mortality.Receiver operating characteristic (ROC) curves were applied to evaluate the predictive value of relevant risk factors for 28 days mortality.Results:There were 29 death patients among 291 patients with respiratory failure due to AECOPD, with the 28 days mortality of 10.0%, and the survival group contained 262 patients.Compared with survival group, mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), arterial partial pressure of carbon dioxide (PaCO 2), fibrinogen (FIB), use of non-invasive ventilation, and failure in non-invasive ventilation were all higher than those in death group, whereas lymphocyte count and potential of hydrogen (pH)were lower than those in death group (all P<0.05). Multivariate logistic regression analysis showed that MPV( OR=1.83, 95% CI: 1.20-2.78, P=0.005) and PaCO 2( OR=1.04, 95% CI: 1.02-1.06, P=0.001) were independent risk factors for 28 days mortality.The sensitivity and specificity were 82.8% and 63.4% respectively of the two combined indicators in predicting 28 days mortality, with the area under the ROC curve of 0.79, 95% CI: 0.72-0.87, P<0.001. Conclusions:MPV and PaCO 2 are independent risk factors for 28 days mortality in patients with respiratory failure due to AECOPD.The combination of two indicators can effectively predict the occurrence of short-term prognosis.