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目的 分析2021—2024年上海市某医院慢性阻塞性肺疾病急性加重(AECOPD)住院患者用药情况及其年度变化趋势，并量化合并心血管疾病(CVD)对特定药物选择的影响。方法 回顾性纳入2021—2024年上海市某医院AECOPD住院患者(n=2 398)的病例资料，收集其人口学特征、临床情况和10类常用药物的处方数据，并基于ICD-10诊断标准将研究对象分为CVD组(n=1 888)与非CVD组(n=510)。分别采用Logistic回归和χ2检验比较2组各类药物与联合用药使用比例差异，Cochran-Armitage趋势检验分析不同年份药物使用比例的变化趋势及合并CVD的影响。结果 纳入患者的年龄为(77.66±8.97)岁，大多数(86.2%)为男性，住院天数为(12.36±8.73)d，近半数(48.3%)因AECOPD累计住院≥2次。与非CVD组相比，CVD组患者年龄更大、女性比例更高及住院天数更长，差异均有统计学意义(P<0.05)。药物使用比例前3位依次为祛痰药(78.9%)、吸入型糖皮质激素(ICS)(70.1%)和甲基黄嘌呤(65.4%)，且ICS(OR=1.35, 95%CI:1.09～1.68)和甲基黄嘌呤(OR=1.26, 95%CI:1.03～1.56)在CVD组中使用比例更高。常见用药组合中，CVD组甲基黄嘌呤+ICS(51.1%vs 43.5%)、长效β2受体激动剂+长效抗胆碱能药(LABA+LAMA,40.0%vs 35.5%)及三联疗法(LABA+LAMA+ICS,38.0%vs 32.6%)的使用比例均显著高于非CVD组(P<0.05)。年度变化趋势分析显示，2021—2024年LABA、LAMA、ICS和祛痰药在整体研究对象及CVD组中的使用比例均呈现上升趋势，而甲基黄嘌呤呈下降趋势(P<0.05)。结论 该医院AECOPD住院患者整体用药趋势呈现与慢性阻塞性肺疾病全球创议(GOLD)方向一致的积极变化，然而合并CVD人群对甲基黄嘌呤类药物的持续高使用率与指南警示的心血管风险相悖，建议通过建立CVD合并患者个体化用药路径，健全相关用药监测与评估体系，以及加强多学科协作与临床医师教育优化等途径优化治疗策略。
Abstract：AIM To analyze medication patterns and annual trends in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) inpatients(2021-2024) in a hospital in Shanghai, and quantify cardiovascular disease(CVD) comorbidity's impact on specific drug selections. METHODS Medical records of AECOPD inpatients(n=2 398)in a hospital in Shanghai were retrospectively included. Demographic characteristics, hospitalization details, and prescription information for 10 commonly used medication categories were collected. Based on the International Classification of Diseases 10 th Revision(ICD-10), patients were categorized into CVD group(n=1 888) and non-CVD group(n=510). Logistic regression and chi-square test were respectively used to compare the differences in the usage proportions of various drugs and combined drugs between 2 groups. The Cochran-Armitage trend test was used to analyze the changing trends of drug usage proportions in different years and the impact of combined CVD. RESULTS The average age of enrolled patients was(77.66 ± 8.97) years. The majority(86.2%) were male. The average hospital stay was(12.36 ± 8.73) days. Nearly half(48.3%) had been hospitalized more than 2 times due to AECOPD. The CVD group was characterized by the significantly older age, higher proportion of females, and longer hospital stays compared with the non-CVD group, with all differences being statistically significant(P < 0.05). The top three medications by usage rate were mucolytics(78.9%), inhaled corticosteroids(ICS, 70.1%), and methylxanthines(65.4%), while more ICS(OR=1.35, 95% CI: 1.09-1.68) and methylxanthines(OR=1.26, 95% CI: 1.03-1.56) were used in the CVD group. Also, combination therapies including methylxanthines+ICS(51.1% vs 43.5%), long-acting β2-adrenoceptor agonist+long-acting muscarinic antagonist(LABA+LAMA)(40.0% vs 35.5%), and triple therapy(LABA+LAMA+ICS, 38.0% vs 32.6%) were more prevalent in the CVD group(P < 0.05). Annual trends(2021-2024) revealed statistically significant increases in LABA, LAMA, ICS, and mucolytics but a decrease in methylxanthines overall or in the CVD group(P < 0.05). CONCLUSION The overall medication trend of AECOPD inpatients in the hospital has shown a positive change consistent with the direction of the Global Initiative for Chronic Obstructive Lung Disease(COLD). However, for the population with CVD, the continuous high usage rate of methylxanthines is contrary to the cardiovascular risk warnings in the guidelines. It is recommended to optimize the treatment strategy through establishing individualized medication paths for CVD patients, improving the relevant medication monitoring and evaluation system, and strengthening multidisciplinary collaboration and clinical doctor education.
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基本信息:
DOI：10.19577/j.1007-4406.2026.02.002
中图分类号:R95
引用信息:
[1]白海凡,王春燕,范铭,等.上海市某医院COPD急性加重住院患者用药模式及合并心血管疾病对其影响[J].中国临床药学杂志,2026,35(02):106-112.DOI:10.19577/j.1007-4406.2026.02.002.
基金信息:
2023年复旦-闵行健康联合体合作项目（编号2023FM06）; 2023年度闵行区卫生健康委员会科研课题（编号2023MW57）
2026-02-25
2026-02-25