慢性阻塞性肺疾病患者动脉僵硬度的变化及危险因素分析

The changes and risk factors of arterial stiffness degree in patients with chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者动脉僵硬度的变化及影响因素。方法采用回顾性分析2017年8月至2019年12月治疗的COPD患者(观察组)98例的临床资料,纳入同期进行正常体检的无COPD及心血管系统相关疾病者(对照组)98例进行比较。受试者均进行肺功能测定。动脉僵硬度通过检测动脉波速指数方法获得中心动脉的僵硬度;检测动脉压力容积指数获得外周动脉的僵硬度。中心动脉压通过脉搏分析系统获得中心动脉血压。比较2组研究对象的相关血脂代谢指标(三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、同型半胱氨酸),以及炎性反应标志物超敏C-反应蛋白水平。并对相关因素如性别、年龄、BMI、糖尿病史、饮酒史、吸烟史、低氧血症史、FEV1%进行单因素分析;将单因素分析有统计学意义的因素引入多因素Logistic回归分析模型,以COPD合并动脉硬化为因变量,各个因素为自变量,其他因素为协变量进行多因素Logistic回归分析。结果观察组动脉波速指数、动脉压力容积指数、中心动脉血压水平均高于于对照组,差异有统计学意义(t=22.101、t=-9.139、t=6.919,P均<0.001)。多因素Logistic回归分析结果表明:BMI、饮酒史、吸烟史、低氧血症史、FEV1%与COPD合并动脉僵硬度增高仍然存在关联。其中,吸烟、饮酒、低氧血症、低FEV1%为危险因素,低BMI为保护性因素。动脉僵硬度相关指标动脉波速指数、动脉压力容积指数、中心动脉血压以及同型半胱氨酸,超敏C反应蛋白水平也与COPD合并动脉僵硬度增高有关,这些指标越低,发生合并症的危险性越低。结论COPD患者更易发生以动脉硬化为标志的血管系统疾病。针对于危险因素制定恰当的干预治疗策略,从而提高COPD患者的预后。

Objective To investigate the changes and risk factors of arterial stiffness degree in patients with stable chronic obstructive pulmonary disease(COPD).Methods A retrospective case-control study was performed to analyze the clinical data about 98 patients with COPD(observation group)who were treated in our hospital from August 2017 to December 2019,at the same time,the other 98 healthy subjects were enrolled as control group.All the subjects underwent lung function test.the carotid femoral pulse wave velocity(CF-PWV)and carotid radial pulse wave velocity(CR-PWV)were used to measure the arterial velocity index(AVI),and ankle brachial pulse wave velocity(baPWV)was used to measure the arterial pressure volume index(API).The blood lipid metabolism indexes(triglyceride,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,homocysteine)and high-sensitivity C-reactive protein levels,and the related factors including patient’s gender and age,BMI,history of diabetes,drinking history,smoking history,history of hypoxemia,FEV1%were observed and compared between the two groups.Results The levels of arterial wave velocity index(AVI),arterial pressure volume index(API),and central arterial blood pressure in observation group were significantly higher than those in control group(P<0.01).Multivariate logistic regression analysis showed that BMI,drinking history,smoking history,hypoxemia history and low FEV1%were rish factors,and low BMI was protective factor.The lower the arterial stiffness index,the higher the arterial stiffness index,and the higher the risk of COPD.Conclusion The patients with COPD are more likely to suffer from vascular diseases marked by arteriosclerosis,therefor,it is necessary to make appropriate intervention strategies targeted to risk factors,so as to improve the prognosis of patients with COPD factors.