Pizarro Carmen, Linnhoff Fabian, van Essen Fabian, Pingel Simon, Schaefer Christian Alexander, Schahab Nadjib, Fimmers Rolf, Nickenig Georg, Skowasch Dirk
Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany; These authors contributed equally to this work.
Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany.
ERJ Open Res. 2016 Oct 26;2(4). doi: 10.1183/23120541.00037-2016. eCollection 2016 Oct.
In view of their common chronic inflammatory process, we sought to determine the linkage between peripheral artery disease and chronic obstructive pulmonary disease (COPD). 107 COPD patients (mean±sd age 64.6±10.4 years, 52.2% male) and 22 control smokers without previously diagnosed peripheral artery disease underwent standardised angiological examination for lower extremity artery disease (LEAD) and carotid artery disease. LEAD was significantly more prevalent in COPD patients than in controls (80.4% 54.5%, p=0.002). Among COPD patients, 57.0%, 12.2%, 10.3% and 0.9% were found to be in Fontaine stages I, IIA, IIB and III, respectively. As with carotid artery disease, its frequency increased from 36.4% in controls to 58.9% in COPD patients (p=0.003). Carotid plaque burden, LEAD Fontaine degrees as well as pulse wave index and ankle-brachial index manifested significant impairment over percentage predicted forced expiratory volume in 1 s (FEV % pred) (p=0.02, p<0.001, p=0.01 and p<0.001, respectively). Multivariate analysis revealed that COPD Global Initiative for Chronic Obstructive Lung Disease status was the strongest independent predictor for the presence of plaque in lower extremity arteries (odds ratio 1.63, 95% CI 1.19-2.25, p=0.003) and carotids (odds ratio 1.66, 95% CI 1.14-2.44, p=0.009). As compared with control smokers, peripheral artery disease is diagnosed in a sizeable proportion of COPD patients and exhibits significant distributive differences over FEV % pred that exceed the susceptibility conferred by common cardiovascular stressors.
鉴于外周动脉疾病和慢性阻塞性肺疾病（COPD）存在共同的慢性炎症过程，我们试图确定二者之间的联系。107例COPD患者（平均年龄±标准差为64.6±10.4岁，男性占52.2%）和22例无外周动脉疾病既往诊断史的对照吸烟者接受了针对下肢动脉疾病（LEAD）和颈动脉疾病的标准化血管检查。COPD患者中LEAD的患病率显著高于对照组（80.4%对54.5%，p=0.002）。在COPD患者中，分别有57.0%、12.2%、10.3%和0.9%处于Fontaine分期的I期、IIA期、IIB期和III期。与颈动脉疾病一样，其发生率从对照组的36.4%增至COPD患者的58.9%（p=0.003）。颈动脉斑块负荷、LEAD Fontaine分级以及脉搏波指数和踝臂指数在1秒用力呼气容积占预计值百分比（FEV%pred）方面均表现出显著损害（分别为p=0.02、p<0.001、p=0.01和p<0.001）。多变量分析显示，慢性阻塞性肺疾病全球倡议（GOLD）分级是下肢动脉（优势比1.63，95%可信区间1.19 - 2.25，p=0.003）和颈动脉（优势比1.66，95%可信区间1.14 - 2.44，p=0.009）斑块存在的最强独立预测因素。与对照吸烟者相比，相当一部分COPD患者被诊断为外周动脉疾病，且在FEV%pred方面存在显著分布差异，超过了常见心血管应激源所致的易感性。
