慢性阻塞性肺疾病患者贫血的发生率及其临床意义

Clinical Implications in Prevalence of Anemia in Chronic Obstructive Pulmonary Disease

目的:了解贫血在不同肺功能参数的慢性阻塞性肺疾病(COPD)患者中的发生率。方法:回顾性分析2009年1月至2012年12月收治的398例COPD急性期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者和182例支气管哮喘患者的临床资料。将COPD患者按肺功能分为4组:G1组13例:1 s呼出气体体积(forced expiratory volume in one second,FEV1)/最大肺活量(forced vital capacity,FVC)<70%,FEV1%pred≥80%;G2组128例:FEV1/FVC<70%,50%≤FEV1%pred<80%;G3组198例:FEV1/FVC<70%,30%≤FEV1%pred<50%;G4组59例:FEV1/FVC<70%,FEV1%pred<30%。按血红蛋白值将COPD患者分为贫血组和非贫血组。结果:(1)398例AECOPD患者中,贫血者100例(25.13%),均为正细胞正色素贫血;在182例支气管哮喘中,贫血者为10.43%,差异有统计学意义(P<0.01)。(2)G4组患者平均血红蛋白明显高于G1组、G2组和G3组(P<0.05或0.01),G4组贫血发生率低于G1组、G2组(P<0.01)。(3)398例AECOPD患者血红蛋白与体重指数呈正相关(r=0.187,P<0.01),与Pa O2呈负相关(r=-0.127,P<0.05)。与性别、吸烟、血肌酐、Pa CO2无关。结论:在AECOPD患者中贫血发生率高,是其常见的症状,其贫血为正细胞正色素贫血。COPD贫血的发生决定低氧对红细胞生成素产生的刺激效应和全身炎症对红细胞生成素产生的抑制效应之间的平衡。

Objective： To investigate the prevalence of anemia in patients with chronic obstructive pulmonary disease（ COPD） in different lung functional parameters. Methods： A total of 398 patients with acute exacerbation of COPD（ AECOPD） and 182 patients with asthma were enrolled in the study. COPD patients were divided into four groups by lung function way. Group 1（ FEV1 /FVC 70%,FEV1% ≥80%）,group 2（ FEV1 / FVC 70%,50% ≤ FEV1% 80%）,group 3（ FEV1 / FVC 70% 30% ≤FEV1% 50%）,group 4（ FEV1 / FVC 70%,FEV1% 30%）. COPD patients were divided into anemia group and non-anemia group by Hgb way. Results：（ 1） In these 398 AECOPD patients,the overall prevalence of anemia was 25. 13%; so was10. 43% in 182 asthmas. There was significant difference（ P〈0. 01）. The type of anemia in COPD patients appeared to be normocytic and normochromic.（ 2） Patients in group 4 showed significantly higher Hgb values than patients in groups 1,2,3（ P〈0. 05 or 0. 01）. The prevalence of anemia in group 4 was lower than that in group 1 and group 2（ P〈0. 01）.（ 3） Hgb in these 398 AECOPD patients was correlated positively with BMI（ r = 0. 187,P〈0. 01）,negatively with Pa O2（ r =- 0. 127,P〈0. 05）. but there was not association with gender,smoking status,Cr and Pa CO2. Conclusions： The high prevalence of anemia in AECOPD patients in our study supports the notion that anemia is a common syndrome,the type of anemia in which was normocytic and normochromic. The pevanlence of anemia in COPD can be determined by the balance between the stimulating effects of hypoxia on Epo production and inflammation-induced Epo resistance.