Kim Victor, Goel Nishant, Gangar Jinal, Zhao Huaqing, Ciccolella David E, Silverman Edwin K, Crapo James D, Criner Gerard J
Section of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.
Division of Pulmonary and Critical Care Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Chronic Obstr Pulm Dis. 2014;1(2):239-249. doi: 10.15326/jcopdf.1.2.2014.0133#sthash.pvwPnxaI.dpuf.
COPD patients are at increased risk for venous thromboembolism (VTE). VTE however remains under-diagnosed in this population and the clinical profile of VTE in COPD is unclear.
Global initiative for chronic Obstructive Lung Disease (GOLD) stages II-IV participants in the COPD Genetic Epidemiology (COPDGene) study were divided into 2 groups: VTE+, those who reported a history of VTE by questionnaire, and VTE-, those who did not. We compared variables in these 2 groups with either t-test or chi-squared test for continuous and categorical variables, respectively. We performed a univariate logistic regression for VTE, and then a multivariate logistic regression using the significant predictors of interest in the univariate analysis to ascertain the determinants of VTE.
The VTE+ group was older, more likely to be Caucasian, had a higher body mass index (BMI), smoking history, used oxygen, had a lower 6-minute walk distance, worse quality of life scores, and more dyspnea and respiratory exacerbations than the VTE- group. Lung function was not different between groups. A greater percentage of the VTE+ group described multiple medical comorbidities. On multivariate analysis, BMI, 6-minute walk distance, pneumothorax, peripheral vascular disease, and congestive heart failure significantly increased the odds for VTE by history.
BMI, exercise capacity, and medical comorbidities were significantly associated with VTE in moderate to severe COPD. Clinicians should suspect VTE in patients who present with dyspnea and should consider possibilities other than infection as causes of COPD exacerbation.
慢性阻塞性肺疾病（COPD）患者发生静脉血栓栓塞症（VTE）的风险增加。然而，VTE在该人群中仍诊断不足，且COPD患者VTE的临床特征尚不清楚。
慢性阻塞性肺疾病遗传流行病学（COPDGene）研究中全球慢性阻塞性肺疾病倡议（GOLD）II-IV期参与者被分为两组：VTE+组，即通过问卷报告有VTE病史者；VTE-组，即无VTE病史者。我们分别使用t检验或卡方检验比较这两组中连续变量和分类变量的情况。我们对VTE进行单因素逻辑回归分析，然后使用单因素分析中感兴趣的显著预测因素进行多因素逻辑回归分析，以确定VTE的决定因素。
与VTE-组相比，VTE+组年龄更大，更可能为白种人，体重指数（BMI）更高，有吸烟史，使用氧气，6分钟步行距离更短，生活质量评分更差，且呼吸困难和呼吸加重情况更多。两组间肺功能无差异。VTE+组中描述有多种合并症的比例更高。多因素分析显示，BMI、6分钟步行距离、气胸、外周血管疾病和充血性心力衰竭显著增加了有VTE病史的几率。
BMI、运动能力和合并症与中重度COPD患者的VTE显著相关。临床医生应对出现呼吸困难的患者怀疑VTE，并应考虑除感染以外的其他可能导致COPD加重的原因。
