老年慢性阻塞性肺疾病患者动脉硬化与气道阻塞严重度的关系  

Association between airway obstruction and peripheralarterial stiffness in elderly patients with chronicobstructive pulmonary disease

作　　者：付志方[1] 焦红梅[1] 孙丹[1] 李虹[1] 刘新民[1] 

机构地区：[1]北京大学第一医院老年病科,100034

出　　处：《中华老年医学杂志》2014年第3期238-241,共4页Chinese Journal of Geriatrics

摘　　要：目的探讨老年慢性阻塞性肺疾病（COPD）患者气道阻塞严重程度与动脉硬化的关系。方法收集2008年1月至2012年10月诊断为COPD的老年患者81例，根据第1秒用力呼气容积（FEV。）占预计值百分比≥50％分为轻/中度患者（51例），FEV。占预计值百分比〈50％为重度患者（30例）。所有患者均行肱踝脉搏波传导速度（baPWV）检查作为反映外周动脉硬化的指标，行Holter检查计算24h平均心率，并收集患者年龄、性别、体质指数（BMI）、吸烟史、既往病史、合并用药等基本资料以及血脂、血糖、动脉血氧分压（PaO2）、血清超敏C反应蛋白（hs-CRP）进行两组间比较。结果两组患者年龄、性别、吸烟情况、患糖尿病、高血压、冠心病、脂代谢紊乱的比例差异均无统计学意义；重度组患者BMI小于轻/中度组患者[（22．8土4．2）kg/㎡比（25．3±3．2）kg/㎡，t=3．02，P=0．0031，24h平均心率高于轻/中度组患者[（77．4±12．7）次/min比（70．8±9．6）次/min，t=-2．60，P=0．0113，Pa02低于轻／中度组患者[（74．6±13．0）mmHg比（82．4±13．1）mrnHg，t=2．46，P=0．0173。所有患者中有76例（93．8％）外周动脉硬化程度增加（baPwV〉14．00m/s），重度组baPWV高于轻／中度组患者[（20．77±3．71）m/s比（18．84±4．11）m/s，t=2．11，P=0．0383。重度组患者hs-CRP水平高于轻/中度组患者[（6．51士5．66）mg/L比（3．27±3．34）mg/L，t=2．66，P=0．0093。结论COPD患者合并动脉硬化发病率高，且气道阻塞程度越重，外周动脉硬化越严重，可能与COPD患者慢性炎性状态、长期低氧和交感神经过度激活等因素相关。Objective To evaluate the relationship between severity of airway obstruction and peripheral arterial stiffness in patients with chronic obstructive pulmonary disease （COPD）. Methods 81 COPD patients [aged （78.32±6.98）yrs, 73 males, 8 females] from Jan 2008 to Oct 2012 were enrolledin Geriatric Department of Peking University First Hospital. All patients underwent spirometry and Holter evaluation, while age, sex, BMI, smoking pack-years, medical history, blood levels of lipid profiles, glucose, high sensitivity C reactive protein （hsCRP）and arterial oxygen pressure （PaO2）were recorded. The severity of airway obstruction was evaluated by spirometry. The patients were divided into two groups： mild/moderate group [forced expiratory volume in one second （FEV1%） predicted ≥ 50 %, n = 51] and severe group （FEV1% predicted 〈 50% n= 30）. 24-hour average heart rate （HR）was assessed by holter. Arterial stiffness was assessed by the hrachial ankle pulse wave velocity （baPWV）. The baPWV increment was considered to be a direct witness of arterial stiffness increase. Blood levels of lipid profiles, glucose, arterial oxygen pressure （PaO2）and hsCRP were compared between the two groups. Results Age, gender, smoking index, medical history of the two groups were matched. BMI was less in severe group than in mild/moderate group [（22.8± 4.2） kg/m^2 vs （25.3 ± 3.2） kg/m^2 , t= 3. 017, P=0. 05%. 24-hour average HR was higher in severe group than in mild/moderate group [ （77.4 4± 12. 7） bpm vs （70.8± 9.6）bpm, t=-2. 602, P〈0. 051. The PaO2 was lower in severe group than in mild/moderate group[（74.6_＋13.0）mmHg va （82.4~13.1）mmHg, t=2.456, P〈0.05]. There were no differences in blood lipid profile and glucose levels between the two groups. 76 patients （93.4 %）were detected with peripheral arterial stiffness by baPWV〉 14.00 m/s. baPWV was significantly increased in severe group as compared with mild/moderate group [（20. 77± 3. 71 ）m/s va （18.84 ± 1.88

关 键 词：肺疾病 慢性阻塞性 动脉硬化 

分 类 号：R563.9[医药卫生—呼吸系统]