慢性阻塞性肺疾病对冠状动脉病变严重程度的影响研究

Effect of Chronic Obstructive Pulmonary Disease on the Severity of Coronary Artery Disease

背景全身性炎症是冠状动脉疾病(CAD)和慢性阻塞性肺疾病(以下简称慢阻肺)之间的病理生理联系,然而,亚临床慢阻肺对疑似或诊断为冠心病患者的影响尚不清楚。目的探讨慢阻肺对冠状动脉病变严重程度的影响。方法选取2016年1月—2018年1月遵义市第一人民医院呼吸内科和心内科门诊及住院部收治的符合纳入标准的210例患者为研究对象。CAD依据冠状动脉造影(CAG)或双源冠状动脉CT血管造影(CTA)检查进行确诊。根据肺功能检测结果将患者分为慢阻肺组和无慢阻肺组。分析冠状动脉病变严重程度、部位和范围,以及与慢阻肺严重程度的相关性。结果本研究210例患者中138例(65.7%)确诊为CAD;101例(48.1%)确诊为慢阻肺。慢阻肺组CAD、狭窄程度≥50%、累及三支血管、累及多支血管、累及左冠状动脉及重度CAD发生率均高于无慢阻肺组(P<0.05)。重度慢阻肺患者的CAD及狭窄程度≥50%发生率均高于轻度、中度慢阻肺患者(P<0.05)。多因素Logistic回归分析结果显示,慢阻肺〔OR=11.42,95%CI(5.34,24.59),P<0.001〕是CAD的影响因素;慢阻肺是狭窄程度≥50%的冠状动脉病变的影响因素〔OR=4.78,95%CI(2.21,10.34),P<0.001〕。结论在CAD患者中,慢阻肺与冠状动脉病变的严重程度相关。慢阻肺是CAD和狭窄程度≥50%的冠状动脉病变的影响因素。

Background Systemic inflammation is a pathophysiological link between coronary artery disease(CAD)and chronic obstructive pulmonary disease(COPD).However,the impact of subclinical COPD on suspected or diagnosed patients with CAD remains largely unknown.Objective To explore the effect of COPD on the severity of CAD.Methods 210 outpatients and inpatients were recruited from Respiratory Department and Cardiovascular Department,the First People's Hospital of Zunyi between January 2016 and January 2018.All of them were examined by pulmonary function test and coronary angiography or dual-source coronary CTA.Patients were divided into COPD group and non-COPD group.The degree of coronary artery lesions and the correlation of CAD severity with COPD were analyzed.Results 138(65.7%)of the 210 cases received a definite diagnosis of CAD,101 cases(48.1%)were diagnosed as COPD.Compared with those without COPD,COPD patients had higher incidence of CAD,significant stenosis(≥50%),3-vessel CAD,multi-vessel CAD,left main coronary artery lesion,and severe CAD(P<0.05).Severe COPD patients showed higher incidence of CAD and significant stenosis(≥50%)than mild or moderate COPD patients(P<0.05).Multivarite Logistic regression analysis showed that COPD〔OR=11.42,95%CI(5.34,24.59),P<0.001〕was associated with CAD;COPD was associated with CAD with significant stenosis(≥50%)〔OR=4.78,95%CI(2.21,10.34),P<0.001〕.Conclusion In CAD patients,the severity of coronary lesions is associated with COPD.COPD is associated with CAD and coronary lesions with significant stenosis(≥50%).