慢性阻塞性肺疾病合并心血管疾病的危险因素及预后

Risk factors and prognosis of cardiovascular disease in chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病（COPD）合并心血管疾病（CVD）的危险因素及预后。方法选取2004年至2009年我院因COPD急性加重住院的患者为研究对象，按是否合并CVD进行分组，所有患者均详细记录病史、体格检查结果，记录血常规、血脂、血糖、心肌酶等化验及肺功能、心电图、超声心动图等检查，对结果采用SPSS16．0软件进行分析。结果两组患者在年龄、性别、吸烟史方面差异无统计学意义，COPD＋CVD组患者体质量指数（BMI）均值（24．29±4．07）kg／m2，高于COPD组（P=0．011）；COPD＋CVD组合并高血压、高脂血症、糖尿病的比例与COPD组相比[（64．70％VS58．24％）、（17．65％VS9．89％）、（26．47％VS8．79％）]，只有合并糖尿病的比例差异具有统计学意义（P=0．023）；COPD＋CVD组FEV1／FVC、FEV1％pred（吸入支气管扩张剂后）均值低于COPD组[（46．64±8．10）％VS（50．79±10．94）％、（44．62±9．80）％VS（50．21±13．76）％]，差异有统计学意义（P值均〈0．05），且COPD＋CVD组肺功能Ⅲ～Ⅳ级的比例高于COPD组（76．47％VS49．50％）（P=0．016）；COPD＋CVD组患者PaO2低于COPD组[（67．67±10．31）mmHgVS（73．74±13．67）mmHg]（P=0．038）；COPD＋CVD组在与炎症相关的指标如白细胞、中性粒细胞比例、C反应蛋白（CRP）、超敏CRP及纤维蛋白原水平上均高于COPD组（P值均〈0．05），而在血脂、血糖水平上的差异无统计学意义（P值均〉0．05）；COPD＋CVD组患者平均住院天数、平均再住院次数、死亡患者比例高于COPD组[（21．12±9．83）d vs（17．75±7．37）d、（1．59±1．67）次VS（0．90±1．17）次、20．59％VS7．69％]，且差异有统计学意义（P值均〈0．05）。Logistic回归分析表明，BMI、是否合并糖尿病、肺功能、血氧水平及与炎症相关的指标都和COPD合并CVD存在一定相关性，但经多因素Logistic回归分析，只有CRP水平与COPD合并CVD独立相关（P=0．026）。结论传统的CVD危险因素及肺功能的下降都在COPD合并CVD中起一定的作用，这些作用的机制可能与全身炎症和缺氧等因素有关。合并CVD的COPD患者预后差。

Objective To discussion the risk factors and prognosis of chronic obstructive pulmonary disease （COPD） with cardiovascular disease （CVD）. Methods We choose the hospitalized patients diagnosis of AECOPD （ n = 125） during 2004-2009 and group them according to the combination of CVD or not. The history, physical examination, laboratory tests, lung function, ECG and echocardiography were recorded. All data were analysis by SPSS 16.0. Results Of the two groups, there are no significant difference in age,sex and smoking history. The BMI of the group COPD＋CVD is （24.29±4.07） kg/m2 , higher than the group of COPD（ P =0. 011）. About combined disease, the percentage of hypertension Of the COPD＋ CVD group, hyperlipidemia, and diabetes, which are higher than the COPD group[ （64.70 % vs 58.24%）,（17. 65% vs 9.89%）,（26.47% vs 8.79%）], hut only the differences in the percentage of diabetes is significant statistically（ P =0. 023）. There are significant differences in lung function and the percentage of GOLD III-IV between the two groups. The PaO2 level of the group COPD＋CVD is lower than the COPDgroup [（67.67± 10.31） mm Hg vs （73.74± 13.76） mg Hg]（P =0.038）. About laboratory tests, there are significant differences in the inflammation-related indicators such as the count of white blood cell, the proportion of neutrophils, CRP, high sensitivity CRP and Fib（ P 〈0.05） but no significant differences in blood glucose and lipids. The average length of stay, re-hospitalization and the proportion of patients died of COPD＋CVD group are higher than group COPDE（21. 12±9.83） days vs （17.75±7.3） days, （1.59±1.67） times vs （0.90±0.17） times, 20.59% vs 7.69%. Logistic regression analysis showed that BMI, combined with diabetes or not, lung function, blood oxygen levels and inflammation-related indicators are all related with the increase of CVD in COPD. Multivariate Logistic regression analysis show that only CRP level is associated with the increase of CVD in COPD independently（ P =0. 026）. Conclusions Traditional cardiovascular risk factors and the decline of lung function are both play a role in the increase risk of CVD in COPD. The mechanisms of these effects may be related to systemic inflammation and hypoxia etc. The prognosis is poor in COPD patients when they combined with CVD.