慢性阻塞性肺疾病对冠心病患者外周血管病变的影响

Influence of chronic obstructive pulmonary disease on peripheral vascular stenosis in coronary heart disease patients

目的观察冠心病(CHD)合并慢性阻塞性肺疾病(COPD)患者的外周血管病变情况,并探讨其机制。方法对CHD合并COPD患者(86例)和单纯CHD患者(76例)行肾动脉造影、踝臂指数(ABI)、血管内皮舒张功能、颈动脉粥样硬化积分及血气分析、血脂、肾功能检查。结果 CHD合并COPD组较CHD组ABI<0.9和肾动脉狭窄的患者比例升高(74.4%vs39.5%,P<0.01;24.4%vs11.8%,P<0.05),动脉血氧分压下降[(75±8)vs(88±8)mmHg,P<0.01],肱动脉内皮舒张功能明显减弱[(0.7±3.4)%vs(7.0±1.9)%,P<0,01],CHD合并COPD组血清肌酐较CHD组明显升高[(112±43)vs(91±27)μmol/L,P<0.01]。结论 COPD加速了下肢动脉粥样硬化和肾动脉粥样硬化,并导致肾功能不全加重。其机制与内皮舒张功能不全有关。

Objective To investigate the influence of chronic obstructive pulmonary disease（COPD） on peripheral vascular stenosis in coronary heart disease（CHD） patients and its possible mechanism. Methods CHD patients（76 cases） and COPD complicated CHD patients（86 cases） underwent renal artery angiography, ankle brachial index（ABI）, endothelial relaxing function, carotid atherosclerosis score, blood gas, blood lipid, and kidney function examinations. Results The proportions of the patients with ABI 〈 0.9 and with renal artery stenosis in CHD patients complicated with COPD were higher than those in CHD patients respectively（74.4% vs 39.5%, P 〈 0.01; 24.4% vs 11.8%, P 〈 0.05）. Compared with CHD patients, the PaO2 was decreased [（75 ± 8） vs （88 e 8） mmHg, P〈 0.01], the endothelial relaxing function was impaired [（0.7±3.4）% vs （7.0± 1.9）%, P〈 0.01], and the creatinine levels were significantly increased [（112 ± 43）vs （91 ± 27） μmol/L, P〈 0.01] in CHD patients complicated with COPD. Conclusion COPD promotes the atherosclerosis, especially in renal artery and lower extremity arteries, and aggravates renal dysfunction. The mechanism may be related to the insufficiency of endothelial relaxing function.