Flessenkaemper Ingo H, Loddenkemper Robert, Roll Stephanie, Enke-Melzer Kathrin, Wurps Henrik, Bauer Torsten T
Department for Vascular Medicine, Helios Klinikum Emil von Behring, Berlin, Germany.
Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany.
Int J Chron Obstruct Pulmon Dis. 2015 Jun 10;10:1085-91. doi: 10.2147/COPD.S81439. eCollection 2015.
Screening for abdominal aortic aneurysm (AAA) in "men aged over 65 years who have ever smoked" is a recommended policy. To reduce the number of screenings, it may be of value to define subgroups with a higher prevalence of AAA. Since chronic obstructive pulmonary disease (COPD) and AAA are associated with several common risk factors, this study investigates the prevalence of AAA in COPD patients.
Patients with COPD were identified via the hospital information system. Inclusion criteria were: COPD stage I-IV, ability to give full consent, and age >18 years; exclusion criteria were: patient too obese for an ultrasound check, previously diagnosed AAA, prior surgery for AAA, or ethical grounds such as concomitant advanced malignant or end-stage disease. The primary endpoint of the study was an aortic diameter measured by ultrasound of ≥30 mm. Defined secondary endpoints were evaluated on the basis of medical records and interviews.
Of the 1,180 identified COPD patients, 589 were included in this prospective study. In 22 patients (3.70%), the aortic diameter was ≥30 mm, representing an AAA prevalence of 6.72% among males aged >65 years. The risk of AAA increased with the following comorbidities/risk factors: male sex (odds ratio [OR] 2.98), coronary heart disease (OR 2.81), peripheral arterial occlusive disease (OR 2.47), hyperlipoproteinemia (OR 2.77), AAA in the family history (OR 3.95), and COPD stage I/II versus IV (OR 1.81).
The overall AAA prevalence of 3.7% in our group of COPD patients is similar to that of the general population aged >65 years. However, the frequency of AAA in male COPD patients aged >65 years is considerably higher (6.72%) and increased further still in those individuals with additional comorbidities/risk factors. Defining subgroups with a higher risk of AAA may increase the efficiency of screening.
对“65岁以上有吸烟史的男性”进行腹主动脉瘤（AAA）筛查是一项推荐政策。为减少筛查次数，确定AAA患病率较高的亚组可能有价值。由于慢性阻塞性肺疾病（COPD）和AAA有几个共同的危险因素，本研究调查了COPD患者中AAA的患病率。
通过医院信息系统识别COPD患者。纳入标准为：COPD I-IV期、能完全知情同意且年龄>18岁；排除标准为：患者过于肥胖无法进行超声检查、既往诊断为AAA、既往接受过AAA手术或存在伦理问题如合并晚期恶性疾病或终末期疾病。本研究的主要终点是超声测量的主动脉直径≥30mm。根据病历和访谈评估定义的次要终点。
在1180名确诊的COPD患者中，589名被纳入本前瞻性研究。22名患者（3.70%）的主动脉直径≥30mm，在65岁以上男性中AAA患病率为6.72%。AAA风险随以下合并症/危险因素增加：男性（比值比[OR]2.98）、冠心病（OR 2.81）、外周动脉闭塞性疾病（OR 2.47）、高脂蛋白血症（OR 2.77）、家族史中有AAA（OR 3.95）以及COPD I/II期与IV期相比（OR 1.81）。
我们这组COPD患者的总体AAA患病率为3.7%，与65岁以上普通人群相似。然而，65岁以上男性COPD患者中AAA的发生率相当高（6.72%），在有其他合并症/危险因素的个体中进一步增加。确定AAA风险较高的亚组可能会提高筛查效率。
