Lainscak Mitja, Hodoscek Lea Majc, Düngen Hans-Dirk, Rauchhaus Mathias, Doehner Wolfram, Anker Stefan D, von Haehling Stephan
University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
Wien Klin Wochenschr. 2009;121(9-10):309-13. doi: 10.1007/s00508-009-1185-8.
Like chronic heart failure, chronic obstructive pulmonary disease (COPD) is an enormous public health problem in industrialized countries. Our aim was to determine the prevalence and clinical impact of COPD among patients hospitalized for heart failure in a community hospital serving a population of 125,000 people.
Between 2001 and 2003 a total of 638 patients (73 +/- 10 years, 48% men, 74% NYHA class III) were identified with a discharge diagnosis of heart failure. Medical charts were reviewed and vital status was obtained from a Central Population Registry.
COPD was diagnosed in 106 (17%) patients whose age was similar to those without COPD (73 +/- 9 vs. 73 +/- 11 years, P = 0.35). Patients with COPD were more often males (65% vs. 45%, P < 0.001). There were no differences in arterial hypertension, atrial fibrillation, diabetes mellitus and most laboratory markers except hemoglobin (141 +/- 20 vs. 132 +/- 20 g/l, P < 0.001) and uric acid (453 +/- 136 vs. 414 +/- 139 mmol/l, P = 0.013). At discharge, patients with COPD were less likely to receive beta-blockers (12% vs. 28%, odds ratio 0.35, 95% CI0.19-0.64). During follow-up, patients with COPD had higher mortality (73% vs. 60%, P = 0.016, hazard ratio 1.48, 95% CI 1.15-1.90). Kaplan-Meier (log-rank test, P = 0.002) and Cox proportional hazard analysis, adjusted for age, sex, hemoglobin, uric acid, and treatment with beta-blockers and furosemide (hazard ratio 1.38, 95% CI1.04-1.83, P = 0.024) demonstrated the prognostic importance of COPD.
COPD is frequent among hospitalized patients with heart failure. Beta-blockers are largely underused, which is probably a major reason for the higher mortality observed in patients with concomitant chronic heart failure and COPD.
与慢性心力衰竭一样，慢性阻塞性肺疾病（COPD）在工业化国家也是一个重大的公共卫生问题。我们的目的是确定在一家为12.5万人口服务的社区医院中，因心力衰竭住院的患者中COPD的患病率及其临床影响。
在2001年至2003年期间，共确定了638例出院诊断为心力衰竭的患者（年龄73±10岁，男性占48%，74%为纽约心脏协会（NYHA）III级）。查阅了病历，并从中央人口登记处获取了生命状态信息。
106例（17%）患者被诊断为COPD，其年龄与无COPD的患者相似（73±9岁 vs. 73±11岁，P = 0.35）。COPD患者男性比例更高（65% vs. 45%，P < 0.001）。除血红蛋白（141±20 vs. 132±20 g/l，P < 0.001）和尿酸（453±136 vs. 414±139 mmol/l，P = 0.013）外，动脉高血压、心房颤动、糖尿病和大多数实验室指标均无差异。出院时，COPD患者接受β受体阻滞剂治疗的可能性较小（12% vs. 28%，比值比0.35，95%置信区间0.19 - 0.64）。在随访期间，COPD患者的死亡率更高（73% vs. 60%，P = 0.016，风险比1.48，95%置信区间1.15 - 1.90）。Kaplan - Meier分析（对数秩检验，P = 0.002）和Cox比例风险分析，校正年龄、性别、血红蛋白、尿酸以及β受体阻滞剂和呋塞米治疗情况后（风险比1.38，95%置信区间1.04 - 1.83，P = 0.024），证明了COPD的预后重要性。
在因心力衰竭住院的患者中，COPD很常见。β受体阻滞剂的使用严重不足，这可能是合并慢性心力衰竭和COPD的患者死亡率较高的主要原因。
