Academic Unit of Respiratory Medicine, University College London Medical School, London, England.
Academic Unit of Respiratory Medicine, University College London Medical School, London, England.
Chest. 2012 Apr;141(4):851-857. doi: 10.1378/chest.11-0853. Epub 2011 Sep 22.
Comorbid ischemic heart disease (IHD) is a common and important cause of morbidity and mortality in patients with COPD. The impact of IHD on COPD in terms of a patient's health status, exercise capacity, and symptoms is not well understood.
We analyzed stable-state data of 386 patients from the London COPD cohort between 1995 and 2009 and prospectively collected exacerbation data in those who had completed symptom diaries for ≥ 1 year.
Sixty-four patients (16.6%) with IHD had significantly worse health status as measured by the St. George Respiratory Questionnaire (56.9 ± 18.5 vs 49.1 ± 19.0, P = .003), and a larger proportion of this group reported more severe breathlessness in the stable state, with a Medical Research Council dyspnea score of ≥ 4 (50.9% vs 35.1%, P = .029). In subsets of the sample, stable patients with COPD with IHD had a higher median (interquartile range [IQR]) serum N-terminal pro-brain natriuretic peptide concentration than those without IHD (38 [15, 107] pg/mL vs 12 [6, 21] pg/mL, P = .004) and a lower exercise capacity (6-min walk distance, 225 ± 89 m vs 317 ± 85 m; P = .002). COPD exacerbations were not more frequent in patients with IHD (median, 1.95 [IQR, 1.20, 3.12] vs 1.86 (IQR, 0.75, 3.96) per year; P = .294), but the median symptom recovery time was 5 days longer (17.0 [IQR, 9.8, 24.2] vs 12.0 [IQR, 8.0, 18.0]; P = .009), resulting in significantly more days per year reporting exacerbation symptoms (median, 35.4 [IQR, 13.4, 60.7] vs 22.2 [IQR, 5.7, 42.6]; P = .028). These findings were replicated in multivariate analyses allowing for age, sex, FEV(1), and exacerbation frequency where applicable.
Comorbid IHD is associated with worse health status, lower exercise capacity, and more dyspnea in stable patients with COPD as well as with longer exacerbations but not with an increased exacerbation frequency.
合并缺血性心脏病（IHD）是 COPD 患者发病率和死亡率的常见且重要原因。IHD 对 COPD 的影响，包括患者的健康状况、运动能力和症状，目前尚未完全清楚。
我们分析了 1995 年至 2009 年伦敦 COPD 队列中 386 例患者的稳定状态数据，并前瞻性收集了完成症状日记≥1 年患者的加重数据。
64 例（16.6%）合并 IHD 的患者健康状况明显较差，圣乔治呼吸问卷（St. George Respiratory Questionnaire）评分（56.9±18.5 与 49.1±19.0，P=0.003）更低，且更大概率报告稳定状态下呼吸急促更严重，呼吸困难医学研究委员会（Medical Research Council）评分≥4 分（50.9%与 35.1%，P=0.029）。在样本的亚组中，合并 IHD 的 COPD 稳定患者的中位（四分位距 [IQR]）血清 N 末端脑利钠肽前体浓度高于无 IHD 患者（38[15，107]pg/ml 与 12[6，21]pg/ml，P=0.004），运动能力更低（6 分钟步行距离，225±89m 与 317±85m；P=0.002）。合并 IHD 的 COPD 患者的加重发作并不更频繁（中位数，1.95[IQR，1.20，3.12]与 1.86[IQR，0.75，3.96]/年；P=0.294），但症状恢复时间中位数延长 5 天（17.0[IQR，9.8，24.2]与 12.0[IQR，8.0，18.0]；P=0.009），导致每年报告加重症状的天数显著增加（中位数，35.4[IQR，13.4，60.7]与 22.2[IQR，5.7，42.6]；P=0.028）。在允许年龄、性别、FEV1 和加重发作频率（如适用）的多元分析中，也得到了类似的结果。
合并 IHD 与 COPD 稳定患者的健康状况更差、运动能力更低、呼吸困难更严重相关，同时也与加重发作持续时间更长有关，但与加重发作频率增加无关。
