Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Vasc Endovasc Surg. 2012 Aug;44(2):153-7. doi: 10.1016/j.ejvs.2012.05.016. Epub 2012 Jun 15.
It is currently unclear whether the parallels between abdominal aortic aneurysms (AAAs) and chronic obstructive pulmonary disease (COPD) are explained by common risk factors alone, such as cigarette smoking, or by a predetermined cause. Given the persistent controversy with regard to the association between AAA and COPD, we studied this association in depth.
We conducted a case-control study comparing patients with a small AAA (maximum infrarenal diameter 35-50 mm, n = 221) with controls diagnosed with peripheral artery disease (PAD, n = 87). The controls were matched to the cases for lifetime cigarette smoking. Pulmonary function was measured by spirometry, and all subjects completed a questionnaire on medical history and smoking habits (current, former and never smokers).
Aneurysm patients were similar to controls with respect to gender (p = 0.71), lifetime cigarette smoking (39 vs. 34 pack years, p = 0.23) and history of cardiovascular disease (45% vs. 55%, p = 0.12). Aneurysm patients had more airway obstruction (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) (0.69 ± 0.12 vs. 0.78 ± 0.11, p < 0.001)), which was most pronounced in never smokers (0.73 ± 0.07 vs. 0.86 ± 0.07, p < 0.001). COPD was more prevalent in aneurysm patients (44%; 98/221) than in controls (20%; 17/87) (adjusted odds ratio (OR) 3.0; 95% confidence interval (95%CI) 1.6-5.5, p < 0.001). In particular, a major proportion of AAA patients was newly diagnosed with COPD; only 40 of 98 patients (41%) with COPD (mild, moderate or severe/very severe) were known before with obstructive pulmonary defects and received treatment.
This study confirms an association between AAA and COPD and shows that this association is independent from smoking. Findings also demonstrate that COPD is under-diagnosed in AAA patients.
目前尚不清楚腹主动脉瘤（AAA）和慢性阻塞性肺疾病（COPD）之间的相似性仅归因于共同的风险因素（如吸烟），还是归因于预先确定的病因。鉴于 AAA 和 COPD 之间的关联仍存在争议，我们对此进行了深入研究。
我们进行了一项病例对照研究，比较了 221 例小 AAA（最大肾下直径 35-50mm）患者与 87 例诊断为外周动脉疾病（PAD）的对照组。对照组与病例组按终生吸烟量匹配。通过肺活量计测量肺功能，所有受试者均完成了一份关于病史和吸烟习惯（当前、曾经和从不吸烟者）的问卷。
与对照组相比，AAA 患者在性别（p=0.71）、终生吸烟量（39 与 34 包年，p=0.23）和心血管疾病史（45%与 55%，p=0.12）方面无显著差异。AAA 患者的气道阻塞更为严重（用力呼气量/用力肺活量（FEV1/FVC）（0.69±0.12 与 0.78±0.11，p<0.001）），在从不吸烟者中更为明显（0.73±0.07 与 0.86±0.07，p<0.001）。与对照组（20%，17/87）相比，AAA 患者中 COPD 更为常见（44%，98/221）（调整后的比值比（OR）3.0；95%置信区间（95%CI）1.6-5.5，p<0.001）。特别是，很大一部分 AAA 患者是新诊断出患有 COPD 的，98 例 COPD 患者（轻度、中度或重度/极重度）中仅有 40 例（41%）之前已知存在阻塞性肺缺陷并接受了治疗。
本研究证实了 AAA 和 COPD 之间存在关联，且该关联独立于吸烟。研究结果还表明，AAA 患者中 COPD 的诊断不足。
