Pobeha P, Skyba P, Joppa P, Kluchova Z, Szaboova E, Tkac I, Tkacova R
Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, PJ Safarik University Kosice, Slovakia.
Bratisl Lek Listy. 2011;112(1):24-8.
Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Several large population-based cohort studies identified an association between reduced lung function and increased intima-media thickness (IMT). Nevertheless, a vast majority of subjects in these studies did not suffer from COPD and thus it remains unclear whether IMT differs among various stages of COPD severity. The aim of the present pilot study was to evaluate IMT in central European patients with moderate, severe and very severe COPD.
In forty-nine patients (34 men, 15 women; mean age 66.1 +/- 10.9 years) with COPD, the combined thickness of intima and media layers of the common carotid arteries was measured using B-mode ultrasound imaging.
Increased cardiovascular disease risk as evidenced by carotid IMT values greater or equal to 75th percentile were present in 14 (28.6%), whereas IMT hypertrophy (IMT values greater or equal 0.80 mm) was present in 24 (49.0%) of patients. Average IMT in the entire cohort was 0.85 +/- 0.21 mm, with no significant differences from stage II to stages III and IV of COPD.
Present results indicate a high prevalence of IMT hypertrophy and increased cardiovascular disease risk as assessed by carotid ultrasonography in COPD patients with a broad spectrum of airway obstruction severity. The lack of differences in carotid IMT between various stages of lung impairment severity suggests that atherosclerosis starts early in the course of COPD. Therefore, the need to screen patients for the presence of concomitant atherosclerosis in early stages of COPD severity may be warranted (Tab. 2, Ref. 33).
慢性阻塞性肺疾病（COPD）与心血管疾病发病率和死亡率增加相关。几项基于大规模人群的队列研究发现肺功能降低与内膜中层厚度（IMT）增加之间存在关联。然而，这些研究中的绝大多数受试者并未患有COPD，因此尚不清楚IMT在COPD严重程度的各个阶段是否存在差异。本初步研究的目的是评估中欧地区中度、重度和极重度COPD患者的IMT。
对49例COPD患者（34例男性，15例女性；平均年龄66.1±10.9岁），使用B型超声成像测量颈总动脉内膜和中膜层的联合厚度。
颈动脉IMT值大于或等于第75百分位数表明心血管疾病风险增加，14例（28.6%）患者存在这种情况，而24例（49.0%）患者存在IMT增厚（IMT值大于或等于0.80 mm）。整个队列的平均IMT为0.85±0.21 mm，从COPD II期到III期和IV期无显著差异。
目前的结果表明，在气道阻塞严重程度范围广泛的COPD患者中，通过颈动脉超声检查评估，IMT增厚的患病率较高且心血管疾病风险增加。肺功能损害严重程度不同阶段之间颈动脉IMT缺乏差异表明动脉粥样硬化在COPD病程早期就已开始。因此，在COPD严重程度早期筛查患者是否存在并发动脉粥样硬化可能是必要的（表2，参考文献33）。
