Minakata Yoshiaki, Ueda Hiroki, Akamatsu Keiichiro, Kanda Masae, Yanagisawa Satoru, Ichikawa Tomohiro, Koarai Akira, Hirano Tsunahiko, Sugiura Hisatoshi, Matsunaga Kazuto, Ichinose Masakazu
The Third Department of Internal Medicine, Wakayama Medical University, Wakayama.
Intern Med. 2010;49(24):2687-91. doi: 10.2169/internalmedicine.49.3948. Epub 2010 Dec 15.
Comorbidities of chronic obstructive pulmonary disease (COPD) have been recognized as an important issue in COPD management. We have reported that patients with liver diseases show a higher prevalence of COPD, but the number of patients with liver diseases was small and the details of liver diseases were not clearly investigated. In this study, we investigated the prevalence of COPD in patients with liver diseases by recruiting a large number of patients, and also investigated was the effect of hepatitis virus infection on COPD prevalence.
Six hundred sixty-six patients were recruited from 9 primary care clinics and three hospitals. All of these patients were aged 40 years or older with chronic diseases and had not been diagnosed as having respiratory diseases. A spirometry was performed without administration of an inhaled bronchodilator. Airflow limitation was defined as FEV1/FVC<70%. Underlying diseases were diagnosed by doctors of the clinics or the hospitals.
Two hundred fifty-six patients had liver diseases, and 410 did not. Of 410 patients without liver diseases, 37 patients (9.0%) were diagnosed as COPD, and of 256 patients with liver diseases, 35 patients (13.8%) were COPD. When the prevalence was analyzed according to smoking, age and gender, liver diseases showed a significantly high odds ratio (2.10, 95%CI 1.23-3.57, p=0.006), but hepatitis virus infection showed a non-significant tendency toward a high odds ratio.
The patients with liver diseases had a significantly high prevalence of COPD. The presence of liver disease might become a useful predictor for the early detection of COPD.
慢性阻塞性肺疾病（COPD）的合并症已被公认为是COPD管理中的一个重要问题。我们曾报道，肝病患者中COPD的患病率较高，但肝病患者数量较少，且未对肝病的细节进行明确调查。在本研究中，我们通过招募大量患者来调查肝病患者中COPD的患病率，并研究了肝炎病毒感染对COPD患病率的影响。
从9家基层医疗诊所和3家医院招募了666名患者。所有这些患者年龄在40岁及以上，患有慢性疾病，且未被诊断患有呼吸系统疾病。在未使用吸入性支气管扩张剂的情况下进行肺活量测定。气流受限定义为FEV1/FVC<70%。基础疾病由诊所或医院的医生诊断。
256名患者患有肝病，410名患者未患肝病。在410名无肝病的患者中，37名（9.0%）被诊断为COPD，在256名有肝病的患者中，35名（13.8%）为COPD。当根据吸烟、年龄和性别分析患病率时，肝病显示出显著较高的优势比（2.10，95%CI 1.23 - 3.57，p = 0.006），但肝炎病毒感染显示出优势比升高的趋势不显著。
肝病患者中COPD的患病率显著较高。肝病的存在可能成为早期发现COPD的有用预测指标。
