慢性阻塞性肺疾病急性加重患者的中风风险及中风后不良事件
Risk of Stroke and Post-Stroke Adverse Events in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease.
作者信息
Lin Chao-Shun, Shih Chun-Chuan, Yeh Chun-Chieh, Hu Chaur-Jong, Chung Chi-Li, Chen Ta-Liang, Liao Chien-Chang
机构信息
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
出版信息
PLoS One. 2017 Jan 6;12(1):e0169429. doi: 10.1371/journal.pone.0169429. eCollection 2017.
BACKGROUND
The risk and outcomes of stroke in patients with chronic obstructive pulmonary disease exacerbations (COPDe) remain unclear. We examined whether patients with COPDe faced increased risk of stroke or post-stroke outcomes.
METHODS
Using Taiwan's National Health Insurance Research Database, we identified 1918 adults with COPDe and selected comparison cohorts of 3836 adults with COPD no exacerbations and 7672 adults without COPD who were frequency matched by age and sex in 2000-2008 (Study 1). Stroke event was identified during 2000-2013 follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke associated with COPDe were calculated. In a nested cohort study (Study 2) of 261686 new-diagnosed stroke patients in 2000-2009, we calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke in patients with COPDe.
RESULTS
Patients with COPDe had increased stroke incidence, with an adjusted HR of 1.28 (95% CI, 1.03-1.59). In the Study 2, COPDe were associated with post-stroke mortality (OR, 1.34, 95% CI 1.20-1.52), epilepsy (OR, 1.43; 95% CI, (1.22-1.67), and pneumonia (OR, 1.50; 95% CI, 1.39-1.62). Previous intubation for COPD and inpatient admissions due to COPD were factors associated with post-stroke adverse events.
CONCLUSION
Patients who have had COPDe face increased risks of stroke and post-stroke adverse events.
背景
慢性阻塞性肺疾病急性加重（COPDe）患者中风的风险及预后仍不明确。我们研究了COPDe患者是否面临更高的中风风险或中风后不良预后。
方法
利用台湾国民健康保险研究数据库，我们确定了1918例患有COPDe的成年人，并选择了3836例无急性加重的慢性阻塞性肺疾病（COPD）成年人和7672例无COPD的成年人作为对照队列，这些对照队列在2000 - 2008年按年龄和性别进行频数匹配（研究1）。在2000 - 2013年随访期间确定中风事件。计算与COPDe相关的中风调整风险比（HRs）和95%置信区间（CIs）。在一项对2000 - 2009年新诊断的261686例中风患者的巢式队列研究（研究2）中，我们计算了COPDe患者中风后不良事件的调整比值比（ORs）和95% CIs。
结果
COPDe患者中风发病率增加，调整后的HR为1.28（95% CI，1.03 - 1.59）。在研究2中，COPDe与中风后死亡率（OR，1.34，95% CI 1.20 - 1.52）、癫痫（OR，1.43；95% CI，1.22 - 1.67）和肺炎（OR，1.50；95% CI，1.39 - 1.62）相关。既往因COPD进行插管和因COPD住院是与中风后不良事件相关的因素。
结论
曾患COPDe的患者面临中风及中风后不良事件的风险增加。
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