老年慢性阻塞性肺疾病合并肾功能不全患者心血管疾病的发病状况及危险因素

Cardiovascular Disease Incidence and Risk Factors in Elderly Patients with Chronic Obstructive Pulmonary Disease Combined with Renal Insufficiency

目的调查老年慢性阻塞性肺疾病合并肾功能不全患者心血管疾病发病状况,分析影响老年慢性阻塞性肺疾病合并肾功能不全患者发生心血管疾病的危险因素。方法回顾性选择2018年1月31日-2023年1月31日某院收治的219例老年慢性阻塞性肺疾病合并肾功能不全患者,统计心血管疾病发病情况,根据心血管疾病发生情况将老年慢性阻塞性肺疾病合并肾功能不全患者分为心血管疾病组和非心血管疾病组。比较CAD组和非CAD组临床一般资料和实验室资料的差异,通过多因素Logistic回归分析影响老年慢性阻塞性肺疾病合并肾功能不全患者发生心血管疾病的因素。结果219例患者中107例发生心血管疾病(心血管疾病组),112例未发生心血管疾病(非心血管疾病组)。心血管疾病组年龄、糖尿病比例、近1年慢性阻塞性肺疾病急性加重发作频率≥3次/年比例、空腹血糖、中性粒细胞计数/淋巴细胞计数比值高于非心血管疾病组(P<0.05),第1秒用力呼气容积占预计值百分比、左室射血分数、估算的肾小球滤过率、血红蛋白、1,25-羟维生素D低于非心血管疾病组(P<0.05)。多因素Logistic回归分析结果显示近1年慢性阻塞性肺疾病急性加重发作频率≥3次/年、高中性粒细胞计数/淋巴细胞计数比值是老年慢性阻塞性肺疾病合并肾功能不全患者发生心血管疾病的危险因素(P<0.05),估算的肾小球滤过率、1,25-羟维生素D、血红蛋白是保护因素(P<0.05)。结论老年慢性阻塞性肺疾病合并肾功能不全患者心血管疾病风险较高,高慢性阻塞性肺疾病急性加重发作频率和NLR是心血管疾病发生的危险因素,提高估算的肾小球滤过率、1,25-羟维生素D和血红蛋白有助于降低心血管疾病发生风险。

Objectives This study aims to investigate the incidence of cardiovascular diseases in elderly patients with chronic obstructive pulmonary disease combined with renal insufficiency and analyze the risk factors.Methods 219 elderly patients with COPD combined with renal insufficiency admitted to a hospital from January 31,2018 to January 31,2023 were retrospectively selected.The incidence of CAD was statistically analyzed.According to the occurrence of cardiovascular diseases,the elderly patients with chronic obstructive pulmonary disease and renal insufficiency were divided into cardiovascular disease group and non-cardiovascular disease group.The differences in clinical and laboratory data between CAD and non-CAD groups were compared.Multivariate Logistic regression was used to analyze the influencing factors of CAD in elderly patients with COPD combined with renal insufficiency.Results Among 219 patients,107 patients developed CAD(cardiovascular disease group),and 112 patients did not develop CAD(non-cardiovascular disease group).Age,diabetes rate,frequency of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)≥3 times per year,fasting blood glucose(FPG),and neutrophil count/lymphocyte count ratio in CAD group were higher than those in non-CAD group(P<0.05).The percentage of forced expiratory volume in the first second to the predicted value,left ventricular ejection fraction,estimated glomerular filtration rate,hemoglobin,and 1,25-hydroxyvitamin D were lower than those in the non-CAD group(P<0.05).Multivariate Logistic regression analysis showed that the frequency of AECOPD≥3 times per year and high NLR were the risk factors for CAD in COPD patients with renal insufficiency(P<0.05),while eGFR,1,25(OH)2D,and HGB were the protective factors(P<0.05).Conclusions Elderly patients with COPD combined with renal insufficiency have a higher risk of CAD.High frequency of AECOPD and NLR are risk factors for CAD.Increasing eGFR,1,25(OH)2D and HGB can reduce the risk of CAD.