Article(id=1240413930229650246, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202504145, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1744387200000, receivedDateStr=2025-04-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667326742, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667326742, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667326742, creator=13701087609, updateTime=1773667326742, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2695, endPage=2699, ext={EN=ArticleExt(id=1240413930581971814, articleId=1240413930229650246, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association of serum albumin with the risk of developing respiratory failure in male pneumoconiosis patients with pulmonary infection: a retrospective cohort study, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the association between serum albumin level and the risk of respiratory failure after pulmonary infection in patients with pneumoconiosis.

Methods

This study utilized data of hospitalized pneumoconiosis patients from 2012 to 2021 and employed the Cox model to analyze the association between baseline serum albumin levels and the risk of respiratory failure following pulmonary infection in male pneumoconiosis patients.

Results

The average age of 1 301 male inpatients with pneumoconiosis was 50.94 ±11.12 years, with a median age of 48 years old. Respiratory failure occurred in 194 patients after infection, and the incidence density was 44.14 per 1 000 person-years. Grouped by whether respiratory failure occurred, there were significant differences between the two groups in terms of age, smoking status, drinking status, length of dust exposure, ALB, BMI and stage of pneumoconiosis (P<0.05). Multivariate Cox regression analysis indicated that compared with pneumoconiosis patients with serum ALB≤35.1 g/L, those with ALB≥40.9 g/L had a reduced risk of developing respiratory failure after infection (HR=0.48, 95%CI: 0.02-0.94, P=0.002). Subgroup analysis revealed that compared with the lowest quartile group (Q1) of serum ALB, in the low BMI group (BMI<18.5 kg/m2), patients in the Q4 group of serum ALB had a significantly lower risk of developing respiratory failure after infection (HR=0.36, 95% CI: 0.20-0.64, P=0.001); in normal BMI group (18.5 kg/m2≤BMI<24 kg/m2), the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.22, 95% CI: 0.09-0.53, P=0.001); and in pneumoconiosis stage 3 group, the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.42, 95% CI: 0.25-0.71, P=0.001). The restricted cubic spline plot showed that when ALB>38.1 g/L, the risk of developing respiratory failure after pulmonary infection in male pneumoconiosis patients decreased progressively with increasing baseline serum albumin levels.

Conclusion

High serum albumin is a protective factor for respiratory failure in male pneumoconiosis patients after pulmonary infection. Serum ALB concentration higher than 38.1 g/L can reduce the risk of respiratory failure after infection.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Xue-jie DENG, Chi-fei ZHOU, Wen-ao YU, Wen DU, Yu-qin YAO, Qiu-rong HE), CN=ArticleExt(id=1240413933182440397, articleId=1240413930229650246, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=肺部感染的男性尘肺患者血清白蛋白与呼吸衰竭的发生风险的关联——一项回顾性队列研究, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

研究血清白蛋白(serum albumin, ALB)水平与尘肺患者肺部感染后呼吸衰竭发生风险的关联。

方法

本研究基于2012—2021年住院尘肺患者数据,采用Cox模型分析基线ALB水平与男性尘肺患者肺部感染后发生呼吸衰竭风险的关联。

结果

1 301名男性尘肺住院患者平均年龄为(50.94±11.12)岁,中位数年龄48岁,194名患者感染后发生呼吸衰竭,发病密度44.14/千人年。按是否发生呼吸衰竭分组,两组在年龄、吸烟状况、饮酒状况、接尘工龄、ALB、BMI及尘肺期别上差异显著(P<0.05)。多因素Cox回归分析表明,与ALB≤35.1 g/L的尘肺患者相比,ALB≥40.9 g/L的尘肺患者感染后呼吸衰竭的发病风险降低(HR=0.48,95%CI:0.02~0.94,P=0.002)。亚组分析发现,与ALB Q1组相比,在BMI偏低组(BMI<18.5 kg/m2)中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.36,95% CI:0.20~0.64);在BMI正常组(18.5 kg/m2≤BMI<24.0 kg/m2)中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.22,95% CI:0.09~0.53);在尘肺叁期组中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.42,95% CI:0.25~0.71)。限制性立方样条图显示,当ALB>38.1 g/L时,随着基线ALB浓度的增加,男性尘肺患者肺部感染后呼吸衰竭的发生风险逐渐降低。

结论

高ALB是男性尘肺患者肺部感染后发生呼吸衰竭的保护因素,ALB浓度高于38.1 g/L,可降低感染后呼吸衰竭的发生风险。

, correspAuthors=null, authorNote=null, correspAuthorsNote=
何秋蓉,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Lw5VS3qrTved2wqVbKJD5w==, magXml=2XDE8gYCYS3ftgEckK3/AQ==, pdfUrl=null, pdf=ykogHdgwkLRaX9s0J9CgRg==, pdfFileSize=669873, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=Ch7FUuhlFR4fCzszijHonw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=n/s/2KIWlU97jnN0URNoOQ==, mapNumber=null, authorCompany=null, fund=null, authors=

邓学杰(1999—),男,硕士在读,研究方向:劳动卫生与环境卫生学

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邓学杰(1999—),男,硕士在读,研究方向:劳动卫生与环境卫生学

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Modern Preventive Medicine, 2024, 51(10): 1914-1920.(In Chinese), articleTitle=Study on associations of serum albumin levels with risk of severe or very severe pulmonary ventilation dysfunction in male pneumoconiosis patients, refAbstract=null)], funds=[Fund(id=1240424354207552108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, awardId=U22A20359; U23A20495, language=CN, fundingSource=国家自然科学基金区域创新发展联合基金项目(U22A20359; U23A20495), fundOrder=null, country=null), Fund(id=1240424354341769845, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, awardId=2023NSFSC0649; 2023NSFSC0723, language=CN, fundingSource=四川省科技厅自然科学基金项目(2023NSFSC0649; 2023NSFSC0723), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424347958038753, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, xref=null, ext=[AuthorCompanyExt(id=1240424347966427361, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, companyId=1240424347958038753, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China Occupational Pneumoconiosis Cohort Study workgroup, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1240424347974815970, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, companyId=1240424347958038753, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院,华西职业性尘肺病队列工作组,四川 成都 610041)])], figs=[ArticleFig(id=1240424352949260824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=EN, label=Fig 1, caption=The dose-response relationship between baseline serum albumin concentration and the risk of respiratory failure following infection, figureFileSmall=tJR/kQHCCkj6dkYgLHr3Ew==, figureFileBig=aH7g3rNFh3sWZBSV26qItw==, tableContent=null), ArticleFig(id=1240424353041535519, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=CN, label=图1, caption=基线ALB浓度与感染后呼吸衰竭发生风险的剂量反应关系

注:实线表示HR;阴影部分表示95%CI

, figureFileSmall=tJR/kQHCCkj6dkYgLHr3Ew==, figureFileBig=aH7g3rNFh3sWZBSV26qItw==, tableContent=null), ArticleFig(id=1240424353179947563, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=EN, label=Table 1, caption=

Baseline of pneumoconiosis patients [(n=1 301),n(%),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征未发生
呼吸衰竭
发生
呼吸衰竭
t/χ2P
(n=1 107)(n=194)
年龄(岁)50.10 (10.76)55.69 (11.96)-6.08<0.001
随访时间(d)1 266.07
(942.14)
1 043.89
(769.88)
3.580.002
年龄(岁)35.01<0.001
< 60881 (79.6)116 (59.8)
≥ 60226 (20.4)78 (40.2)
吸烟状况8.070.018
无吸烟史187 (16.9)35 (18.0)
既往吸烟者620 (56.0)125 (64.4)
当前吸烟者300 (27.1)34 (17.5)
饮酒状况6.090.048
无饮酒史614 (55.5)98 (50.5)
当前饮酒者172 (15.5)44 (22.7)
既往饮酒者321 (29.0)52 (26.8)
接尘工龄(年)11.08±8.6812.72±9.38-2.270.017
尘肺期别34.08< 0.001
壹期231 (20.9)19 (9.8)
贰期434 (39.2)55 (28.4)
叁期442 (39.9)120 (61.9)
BMI(kg/m244.56<0.001
<18.5697 (63.0)112 (57.7)
18.5~<24.074 (6.7)41 (21.1)
≥24.0336 (30.4)41 (21.1)
ALB(g/L)25.2<0.001
<35.1258 (23.3)74 (38.1)
35.1~<38.1283 (25.6)44 (22.7)
38.1~<40.9267 (24.1)48 (24.7)
≥40.9299 (27.0)28 (14.4)
), ArticleFig(id=1240424353335136824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=CN, label=表1, caption=

尘肺患者的基线特征分布[(n=1 301),n(%),()]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征未发生
呼吸衰竭
发生
呼吸衰竭
t/χ2P
(n=1 107)(n=194)
年龄(岁)50.10 (10.76)55.69 (11.96)-6.08<0.001
随访时间(d)1 266.07
(942.14)
1 043.89
(769.88)
3.580.002
年龄(岁)35.01<0.001
< 60881 (79.6)116 (59.8)
≥ 60226 (20.4)78 (40.2)
吸烟状况8.070.018
无吸烟史187 (16.9)35 (18.0)
既往吸烟者620 (56.0)125 (64.4)
当前吸烟者300 (27.1)34 (17.5)
饮酒状况6.090.048
无饮酒史614 (55.5)98 (50.5)
当前饮酒者172 (15.5)44 (22.7)
既往饮酒者321 (29.0)52 (26.8)
接尘工龄(年)11.08±8.6812.72±9.38-2.270.017
尘肺期别34.08< 0.001
壹期231 (20.9)19 (9.8)
贰期434 (39.2)55 (28.4)
叁期442 (39.9)120 (61.9)
BMI(kg/m244.56<0.001
<18.5697 (63.0)112 (57.7)
18.5~<24.074 (6.7)41 (21.1)
≥24.0336 (30.4)41 (21.1)
ALB(g/L)25.2<0.001
<35.1258 (23.3)74 (38.1)
35.1~<38.1283 (25.6)44 (22.7)
38.1~<40.9267 (24.1)48 (24.7)
≥40.9299 (27.0)28 (14.4)
), ArticleFig(id=1240424353481937472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=EN, label=Table 2, caption=

Univariate and multivariate Cox regression analysis of risk factors for respiratory failure in patients with pneumoconiosis after infection

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素Cox回归分析多因素Cox回归分析
HR(95%CIPHR(95%CIP
年龄(岁)
< 601(Ref)1(Ref)
≥ 602.48(2.20~2.77)<0.0012.48(2.14~2.82)<0.001
吸烟状况
无吸烟史1(Ref)1(Ref)
既往吸烟者1.02(0.65~1.4)0.9160.98(0.6~1.37)0.938
当前吸烟者0.62(0.15~1.09)0.0480.6(0.12~1.08)0.037
饮酒状况
无饮酒史1(Ref)1(Ref)
既往饮酒者1.50(1.14~1.85)0.0261.31(0.95~1.68)0.146
当前饮酒者1.03(0.69~1.36)0.8751.40(1.06~1.75)0.057
接尘工龄(年)1.02(1.01~1.04)0.0011.00(0.98~1.01)0.789
BMI(kg/m2
<18.51(Ref)1(Ref)
18.5~<240.31(-0.04~0.67)<0.0010.39(0.02~0.77)<0.001
≥240.21(-0.22~0.65)<0.0010.30(-0.16~0.76)<0.001
尘肺期别
壹期1(Ref)1(Ref)
贰期1.57(1.05~2.09)0.0891.72(1.19~2.24)0.043
叁期3.02(2.54~3.51)<0.0012.86(2.37~3.35)<0.001
ALB(g/L)
<35.11(Ref)1(Ref)
35.1~<38.10.47(0.1~0.84)<0.0010.62(0.23~1.00)0.014
38.1~<40.90.50(0.13~0.86)<0.0010.69(0.31~1.07)0.059
≥40.90.31(-0.12~0.75)<0.0010.48(0.02~0.94)0.002
), ArticleFig(id=1240424353595183691, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=CN, label=表2, caption=

尘肺病患者感染后发生呼吸衰竭风险影响因素的单因素、多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量单因素Cox回归分析多因素Cox回归分析
HR(95%CIPHR(95%CIP
年龄(岁)
< 601(Ref)1(Ref)
≥ 602.48(2.20~2.77)<0.0012.48(2.14~2.82)<0.001
吸烟状况
无吸烟史1(Ref)1(Ref)
既往吸烟者1.02(0.65~1.4)0.9160.98(0.6~1.37)0.938
当前吸烟者0.62(0.15~1.09)0.0480.6(0.12~1.08)0.037
饮酒状况
无饮酒史1(Ref)1(Ref)
既往饮酒者1.50(1.14~1.85)0.0261.31(0.95~1.68)0.146
当前饮酒者1.03(0.69~1.36)0.8751.40(1.06~1.75)0.057
接尘工龄(年)1.02(1.01~1.04)0.0011.00(0.98~1.01)0.789
BMI(kg/m2
<18.51(Ref)1(Ref)
18.5~<240.31(-0.04~0.67)<0.0010.39(0.02~0.77)<0.001
≥240.21(-0.22~0.65)<0.0010.30(-0.16~0.76)<0.001
尘肺期别
壹期1(Ref)1(Ref)
贰期1.57(1.05~2.09)0.0891.72(1.19~2.24)0.043
叁期3.02(2.54~3.51)<0.0012.86(2.37~3.35)<0.001
ALB(g/L)
<35.11(Ref)1(Ref)
35.1~<38.10.47(0.1~0.84)<0.0010.62(0.23~1.00)0.014
38.1~<40.90.50(0.13~0.86)<0.0010.69(0.31~1.07)0.059
≥40.90.31(-0.12~0.75)<0.0010.48(0.02~0.94)0.002
), ArticleFig(id=1240424353741984341, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=EN, label=Table 3, caption=

Association between ALB and the risk of respiratory failure after infection among pneumoconiosis patients, stratified by BMI and pneumoconiosis stage

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1Q2[HR(95%CI)]P1值Q3[HR(95%CI)]P2值Q4[HR(95%CI)]P3值
BMI(kg/m2
<18.51(Ref)0.49(0.30~0.80)0.0040.62(0.39~1.00)0.0490.36(0.20~0.64)0.001
18.5~<241(Ref)0.38(0.16~0.87)0.0210.27(0.12~0.63)0.0020.22(0.09~0.53)0.001
≥241(Ref)1.09(0.47~2.51)0.3580.92(0.41~2.04)0.3880.95(0.35~2.58)0.053
尘肺期别
壹期1(Ref)0.45(0.22~0.92)0.0290.54(0.28~1.07)0.0760.27(0.12~0.61)0.002
贰期1(Ref)0.6(0.20~1.79)0.3580.59(0.18~1.94)0.3880.12(0.01~1.03)0.053
叁期1(Ref)0.54(0.33~0.88)0.0120.49(0.31~0.78)0.0030.42(0.25~0.71)0.001
), ArticleFig(id=1240424353897173596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413930229650246, language=CN, label=表3, caption=

以BMI、尘肺期别分层后ALB与尘肺患者感染后发生呼吸衰竭发生风险的相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1Q2[HR(95%CI)]P1值Q3[HR(95%CI)]P2值Q4[HR(95%CI)]P3值
BMI(kg/m2
<18.51(Ref)0.49(0.30~0.80)0.0040.62(0.39~1.00)0.0490.36(0.20~0.64)0.001
18.5~<241(Ref)0.38(0.16~0.87)0.0210.27(0.12~0.63)0.0020.22(0.09~0.53)0.001
≥241(Ref)1.09(0.47~2.51)0.3580.92(0.41~2.04)0.3880.95(0.35~2.58)0.053
尘肺期别
壹期1(Ref)0.45(0.22~0.92)0.0290.54(0.28~1.07)0.0760.27(0.12~0.61)0.002
贰期1(Ref)0.6(0.20~1.79)0.3580.59(0.18~1.94)0.3880.12(0.01~1.03)0.053
叁期1(Ref)0.54(0.33~0.88)0.0120.49(0.31~0.78)0.0030.42(0.25~0.71)0.001
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肺部感染的男性尘肺患者血清白蛋白与呼吸衰竭的发生风险的关联——一项回顾性队列研究
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邓学杰 , 周驰斐 , 喻文鳌 , 杜文 , 姚于勤 , 何秋蓉
现代预防医学 | 流行病与统计方法 2025,52(15): 2695-2699
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现代预防医学 | 流行病与统计方法 2025, 52(15): 2695-2699
肺部感染的男性尘肺患者血清白蛋白与呼吸衰竭的发生风险的关联——一项回顾性队列研究
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邓学杰, 周驰斐, 喻文鳌, 杜文, 姚于勤, 何秋蓉
作者信息
  • 四川大学华西公共卫生学院/华西第四医院,华西职业性尘肺病队列工作组,四川 成都 610041
  • 邓学杰(1999—),男,硕士在读,研究方向:劳动卫生与环境卫生学

通讯作者:

何秋蓉,E-mail:
Association of serum albumin with the risk of developing respiratory failure in male pneumoconiosis patients with pulmonary infection: a retrospective cohort study
Xue-jie DENG, Chi-fei ZHOU, Wen-ao YU, Wen DU, Yu-qin YAO, Qiu-rong HE
Affiliations
  • West China Occupational Pneumoconiosis Cohort Study workgroup, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202504145
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目的

研究血清白蛋白(serum albumin, ALB)水平与尘肺患者肺部感染后呼吸衰竭发生风险的关联。

方法

本研究基于2012—2021年住院尘肺患者数据,采用Cox模型分析基线ALB水平与男性尘肺患者肺部感染后发生呼吸衰竭风险的关联。

结果

1 301名男性尘肺住院患者平均年龄为(50.94±11.12)岁,中位数年龄48岁,194名患者感染后发生呼吸衰竭,发病密度44.14/千人年。按是否发生呼吸衰竭分组,两组在年龄、吸烟状况、饮酒状况、接尘工龄、ALB、BMI及尘肺期别上差异显著(P<0.05)。多因素Cox回归分析表明,与ALB≤35.1 g/L的尘肺患者相比,ALB≥40.9 g/L的尘肺患者感染后呼吸衰竭的发病风险降低(HR=0.48,95%CI:0.02~0.94,P=0.002)。亚组分析发现,与ALB Q1组相比,在BMI偏低组(BMI<18.5 kg/m2)中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.36,95% CI:0.20~0.64);在BMI正常组(18.5 kg/m2≤BMI<24.0 kg/m2)中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.22,95% CI:0.09~0.53);在尘肺叁期组中,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.42,95% CI:0.25~0.71)。限制性立方样条图显示,当ALB>38.1 g/L时,随着基线ALB浓度的增加,男性尘肺患者肺部感染后呼吸衰竭的发生风险逐渐降低。

结论

高ALB是男性尘肺患者肺部感染后发生呼吸衰竭的保护因素,ALB浓度高于38.1 g/L,可降低感染后呼吸衰竭的发生风险。

血清白蛋白  /  男性尘肺患者  /  呼吸衰竭  /  保护因素
Objective

To study the association between serum albumin level and the risk of respiratory failure after pulmonary infection in patients with pneumoconiosis.

Methods

This study utilized data of hospitalized pneumoconiosis patients from 2012 to 2021 and employed the Cox model to analyze the association between baseline serum albumin levels and the risk of respiratory failure following pulmonary infection in male pneumoconiosis patients.

Results

The average age of 1 301 male inpatients with pneumoconiosis was 50.94 ±11.12 years, with a median age of 48 years old. Respiratory failure occurred in 194 patients after infection, and the incidence density was 44.14 per 1 000 person-years. Grouped by whether respiratory failure occurred, there were significant differences between the two groups in terms of age, smoking status, drinking status, length of dust exposure, ALB, BMI and stage of pneumoconiosis (P<0.05). Multivariate Cox regression analysis indicated that compared with pneumoconiosis patients with serum ALB≤35.1 g/L, those with ALB≥40.9 g/L had a reduced risk of developing respiratory failure after infection (HR=0.48, 95%CI: 0.02-0.94, P=0.002). Subgroup analysis revealed that compared with the lowest quartile group (Q1) of serum ALB, in the low BMI group (BMI<18.5 kg/m2), patients in the Q4 group of serum ALB had a significantly lower risk of developing respiratory failure after infection (HR=0.36, 95% CI: 0.20-0.64, P=0.001); in normal BMI group (18.5 kg/m2≤BMI<24 kg/m2), the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.22, 95% CI: 0.09-0.53, P=0.001); and in pneumoconiosis stage 3 group, the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.42, 95% CI: 0.25-0.71, P=0.001). The restricted cubic spline plot showed that when ALB>38.1 g/L, the risk of developing respiratory failure after pulmonary infection in male pneumoconiosis patients decreased progressively with increasing baseline serum albumin levels.

Conclusion

High serum albumin is a protective factor for respiratory failure in male pneumoconiosis patients after pulmonary infection. Serum ALB concentration higher than 38.1 g/L can reduce the risk of respiratory failure after infection.

Serum albumin  /  Male pneumoconiosis  /  Respiratory failure  /  Protective factor
邓学杰, 周驰斐, 喻文鳌, 杜文, 姚于勤, 何秋蓉. 肺部感染的男性尘肺患者血清白蛋白与呼吸衰竭的发生风险的关联——一项回顾性队列研究. 现代预防医学, 2025 , 52 (15) : 2695 -2699 . DOI: 10.20043/j.cnki.MPM.202504145
Xue-jie DENG, Chi-fei ZHOU, Wen-ao YU, Wen DU, Yu-qin YAO, Qiu-rong HE. Association of serum albumin with the risk of developing respiratory failure in male pneumoconiosis patients with pulmonary infection: a retrospective cohort study[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2695 -2699 . DOI: 10.20043/j.cnki.MPM.202504145
尘肺病是在职业活动中长期吸入不同致病性的生产性粉尘以及肺组织对粉尘的反应而引起的以慢性肺部炎症和进行性肺纤维化为主的间质性肺病[1]。根据《2022年我国卫生健康事业发展统计公报》,全国新报告职业性尘肺病为7 577例[2],其中,呼吸衰竭已成为尘肺患者的主要死因[3-4]。呼吸衰竭是指各种原因引起的肺通气或换气功能严重障碍,使患者无法维持足够的血氧浓度,导致低氧血症,进而引起病理生理变化和代谢紊乱的临床综合征[5]。有多项研究显示[6-9],尘肺患者的呼吸道感染是诱发呼吸衰竭的最主要原因,可占总发病人数的89.74%。
血清白蛋白(serum albumin, ALB)是人体内主要的可溶性蛋白质,具有维持血浆胶体渗透压、维持酸碱平衡、结合和转运多种内外源性分子等作用,可用于评估多种疾病类型住院患者预后情况[10]。有研究显示[11-12],乳酸/白蛋白比值可预测呼吸衰竭和脓毒症,ALB联合纤维蛋白原与白蛋白比值是COVID-19相关急性呼吸衰竭的危险因素。也有研究显示[13-14],尘肺病患者常伴蛋白质不足等营养不良问题,影响生存质量和免疫功能,增加感染风险,降低呼吸肌储备能力,影响肺呼吸功能,进而影响临床治疗及病情控制。ALB水平低会降低机体免疫力,诱发肺部感染,加重呼吸衰竭,增加死亡率。但目前关于ALB在尘肺合并感染患者中与呼吸衰竭发生关联的研究较少,本研究通过回顾性队列研究,分析尘肺住院患者ALB与尘肺感染后呼吸衰竭的关系,为预防尘肺患者感染后呼吸衰竭提供科学依据。
选择在四川大学华西第四医院于2012年1月1日—2021年11月30日经过职业病诊断或医学诊断为尘肺病的住院患者作为研究对象,研究通过伦理审查(批件号:HXSY-EC-2021053)。职业病诊断依据我国法律法规及GBZ 70—2009[15]、GBZ 70—2015标准[16];医学诊断则针对有粉尘接触史且具肺纤维化特征者。纳入标准:(1)2012年1月1日—2021年11月30日,在院住院治疗≥2次,且2次住院间隔≥7 d的尘肺病患者;(2)最后一次住院前至少确诊过1次肺部感染或细菌性/真菌性/重症肺炎。排除标准:(1)首次住院已发生呼吸衰竭;(2)基线患恶性肿瘤、免疫缺陷病等重大疾病;(3)呼吸衰竭时未确诊肺部感染等;(4)数据严重缺失或病案信息逻辑错误;(5)女性尘肺病患者(女性尘肺患者数量太少)。该研究最终纳入1 301人。ALB浓度为研究的主要自变量,以其浓度的上四分位数、中位数和下四分位数为界点将1 301名研究对象分为四组[17](Q1~Q4组)。
本研究数据来自医院病历系统,无系统性缺失,缺失变量为连续型变量,用R的mice包多重填补,取平均值填补缺失部分;分类变量缺失(仅尘肺类别)归入“其他尘肺”纳入分析。定量变量用(均数±标准差)描述,分类变量用频数和百分比描述;定量变量间比较用方差分析,等级变量用Kruskal-Wallis检验,无序分类变量用χ2检验。用Cox比例风险回归模型分析基线特征与呼吸衰竭关系,计算风险比(hazard ratio,HR)值及95%CI,用R 4.2.2和SAS 9.4分析数据,用R 4.2.2绘制限制性立方样条图,统计学检验均采用双侧检验,检验水准α=0.05。
本研究共纳入1 301名男性尘肺患者进行分析,其中未发生呼吸衰竭1 107例(85.09%),发生呼吸衰竭194例(14.91%)。队列的中位随访时间为2.73年,最长随访时间为11.02年,呼吸衰竭的累积发病率为14.91%,发病密度为 44.14/千人年。以是否发生呼吸衰竭分组,其中年龄、饮酒状况、接尘工龄、ALB、BMI以及尘肺期别上具有统计学差异(P<0.05),见表1
采用Cox比例风险回归模型对年龄、吸烟状况、饮酒状况等变量与尘肺患者感染后发生呼吸衰竭的关系进行单因素分析,计算各因素的HR值及95%CI。结果如表2所示,年龄、吸烟状况、饮酒状况、累积接尘时间、BMI、尘肺期别及ALB水平均与尘肺患者感染后呼吸衰竭发病存在统计学关联(P<0.05)。
将单因素的Cox比例风险模型结果中P<0.05的变量纳入到多因素Cox回归模型中,使用逐步回归法,进行自变量的筛选。多因素Cox比例风险回归分析结果如表2所示,与ALB≤35.1 g/L的尘肺患者相比,ALB为35.1 g/L~38.1 g/L和ALB≥40.9 g/L的尘肺患者感染后发生呼吸衰竭的发病风险分别降低38%和52%,HR(95%CI)分别为0.62(0.23~1)与0.48(0.02~0.94)。
为进一步探究各因素对尘肺患者感染后发生呼吸衰竭的影响,我们进行了亚组分析,结果见表3。亚组分析发现:在BMI偏低组(BMI<18.5 kg/m3)和正常组(18.5 kg/m3≤BMI<24.0 kg/m3)以及尘肺叁期中,与ALB Q1组相比,Q4组患者感染后发生呼吸衰竭风险降低(HR=0.36,95% CI:0.20~0.64;HR= 0.22,95%CI:0.09~0.53;HR=0.42,95% CI:0.25~0.71)。
基于多因素Cox模型绘制限制性立方样条图,调整所有基线特征后,以ALB浓度为定量变量分析。结果如图1所示,基线ALB与尘肺患者肺部感染后呼吸衰竭风险无非线性关联,其浓度增加时,该风险逐渐降低(P=0.015)。
尘肺病高发病率和高死亡率源于职业防护不当、缺乏早期诊断及有效治疗,且患者呼吸系统防御机制受损、病程长、免疫力低下,易患多种并发症。其中,呼吸衰竭是最常见且危险的并发症,也是死亡率高的主因,而呼吸道感染是诱发呼吸衰竭的主要原因。因此,了解呼吸道感染诱发呼吸衰竭的影响因素对疾病诊治与预后分析至关重要。
本研究发现,高ALB是男性尘肺患者肺部感染后发生呼吸衰竭的保护因素,维持ALB浓度高于38.1 g/L可降低感染后呼吸衰竭风险,进一步证实了ALB在防控呼吸衰竭中的重要性[18]。ALB是人类血浆中最丰富的蛋白,具有重要的生物活性,是血浆渗透压的主要决定因素[19]。同时,ALB作为营养状况重要评估指标[20],常被用作营养不良、癌症、类风湿性关节炎等多种疾病的预后生物标志物[21]。基线分析显示,超半数尘肺病患者ALB低于医学参考值,反映其营养不良状况,而营养不良是呼吸衰竭的重要影响因素[22]
本研究的亚组分析发现,ALB的保护作用在BMI≤24 kg/m2的尘肺患者中更为显著,发生呼吸衰竭的风险更低。BMI是营养评估众所周知的临床指标[23],然而,呼吸危重症患者更易合并营养不良或营养状态恶化进而导致不良预后,对此类患者应给予营养支持治疗。患者BMI增加,每日的能量需求也增加[24]。因此,当尘肺患者BMI正常或偏低时,ALB水平升高可改善营养状况,满足因气道阻塞、膈肌做功需求增加所需的能量,降低呼吸衰竭风险。这也解释了高BMI尘肺患者即使ALB水平较高,也不能显著降低呼吸衰竭风险。
同时,本研究还发现高水平的ALB在叁期尘肺患者中均降低呼吸衰竭发生的风险。ALB由于其特殊结构可通过与活性氧、活性氮、前列腺素等相结合来调节炎症反应,也可与多种配体结合和捕获自由基而发挥抗氧化的作用[25-27],也通过与血红素的反应促进自由基和活性氧基团的清除[28-29],这有助于减轻尘肺病患者肺组织的局部慢性炎症。另外,持续低ALB可能引发持续炎症,炎症中单核细胞和粒细胞释放的IL-6可抑制白蛋白合成并促进成纤维细胞增殖,导致纤维化[30]。叁期尘肺患者炎症及肺纤维化更严重,较高ALB水平对其改善作用更好[31]。白蛋白在壹期、贰期尘肺并发感染后对呼吸衰竭的保护作用不明显,可能与病理生理特点有关。壹期、贰期尘肺患者肺组织纤维化程度轻,呼吸系统储备功能尚可,本研究结果与现有研究结论相似,无统计学意义[13]
本研究基于十年观察期、超1 000例样本的尘肺病住院患者病历数据进行回顾性队列分析,变量多、证据效力高,为尘肺病及其并发症研究提供参考。但仍存在不足:作为回顾性研究,残余混杂风险大,缺乏对影响白蛋白表达的膳食和营养状况的控制;尘肺患者感染后呼吸衰竭发病风险95%CI较宽,提示精确度需提高,可能因个体差异及样本限于一家医院住院患者,症状较门诊等患者严重,存在外推性问题。
本回顾性队列研究发现,高ALB是男性尘肺患者肺部感染后发生呼吸衰竭的保护因素,可降低其感染后呼吸衰竭风险。作为常规血液检查的关键指标,ALB能显著提高临床医生对尘肺患者风险分层及早期干预的准确性,有效降低尘肺患者肺部感染后呼吸衰竭风险。
  • 国家自然科学基金区域创新发展联合基金项目(U22A20359; U23A20495)
  • 四川省科技厅自然科学基金项目(2023NSFSC0649; 2023NSFSC0723)
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2025年第52卷第15期
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doi: 10.20043/j.cnki.MPM.202504145
  • 接收时间:2025-04-12
  • 首发时间:2026-03-16
  • 出版时间:2025-08-10
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  • 收稿日期:2025-04-12
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国家自然科学基金区域创新发展联合基金项目(U22A20359; U23A20495)
四川省科技厅自然科学基金项目(2023NSFSC0649; 2023NSFSC0723)
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    四川大学华西公共卫生学院/华西第四医院,华西职业性尘肺病队列工作组,四川 成都 610041

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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