慢性阻塞性肺疾病对冠状动脉粥样硬化性心脏病患者的影响

Influence of chronic obstructive pulmonary disease on patients with coronary atherosclerotic heart disease

目的探讨慢性阻塞性肺疾病(COPD)对冠状动脉粥样硬化性心脏病(CHD)患者的影响。方法收集2012年8月至2018年3月于首都医科大学附属北京同仁医院内科住院的CHD患者共121例,其中61例合并COPD,进行横断面分析,比较两组之间冠状动脉造影结果、Gensini评分和高敏C反应蛋白(hs-CRP)的差异。结果CHD合并COPD组患者的Gensini评分较单纯CHD组升高(120.90±90.68比65.27±50.38,t=4.162,P=0.000);CHD合并COPD组发生一支及以上心外膜血管完全或次全闭塞的比例较单纯CHD组高(44.3%比21.7%,χ^2=6.979,P=0.008),两组发生左主干+三支心外膜血管或三支心外膜血管病变的比例相当。CHD合并COPD组的hs-CRP较单纯CHD组高,但差异无统计学意义[(6.95±9.52)mg/L比(5.03±4.90)mg/L,t=1.392,P=0.166]。多因素logistic回归分析显示,COPD与一支及以上心外膜血管完全或次全闭塞独立相关(OR:2.838,95%CI:1.251~6.437,P=0.013)。结论CHD合并COPD患者的冠状动脉狭窄程度更重,出现一支及以上血管完全或次全闭塞的比例更高。COPD对CHD的影响机制可能是全身炎症反应。

Objective To investigate the influence of chronic obstructive pulmonary disease(COPD)on patients with coronary atherosclerotic heart disease(CHD)patients.Methods A total of 121 CHD patients who were admitted to Beijing Tongren Hospital from August 2012 to March 2018,61 of them accompanied with COPD,were analyzed for cross-sectional analysis.Coronary angiographic data,Gensini score and high sensitive C reactive protein(hs-CRP)level was compared between the two groups.Results The Gensini score of patients with CHD combined with COPD group was significantly higher than that of CHD alone(120.90±90.68 vs.65.27±50.38,t=4.162,P=0.000).One or more coronary artery with total occlusion or subtotal occlusion was higher in CHD combined with COPD group than that of CHD group(44.3%vs.21.7%,χ^2=6.979,P=0.008).The hs-CRP level in CHD combined with COPD group was higher than that of the CHD group,but the difference was not statistically significant[(6.95±9.52)mg/L vs.(5.03±4.90)mg/L,t=1.392,P=0.166].Multivariate logistic regression analysis indicated that COPD was an independent risk factor for CHD with one or more coronary artery complete or subtotal occlusion(OR:2.838,95%CI:1.251-6.437,P=0.013).Conclusions Patients with CHD complicated with COPD have a greater degree of coronary artery stenosis.The proportion of one or more complete or subtotal occlusions is higher in CHD with COPD patients.The influence of COPD affecting on CHD may be systemic inflammatory response.