Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA.
Chest. 2018 Mar;153(3):611-617. doi: 10.1016/j.chest.2017.07.003. Epub 2017 Jul 14.
Obesity is common among individuals with COPD and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in patients who are obese.
Using the population-based ED and inpatient sample in three US states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 adults who were obese (40-65 years of age) with COPD who underwent bariatric surgery. The primary outcome was an ED visit or hospitalization for acute exacerbation of COPD (AECOPD) from 2005 through 2011. We compared each patient's risk of the outcome during sequential 12-month periods using presurgery months 13 through 24 as the reference period.
During the 13 to 24 months before bariatric surgery (ie, reference period), 28% (95% CI, 24%-32%) of patients had an ED visit or hospitalization for AECOPD. In the subsequent 12-month presurgery period, the risk did not change materially (31%; 95% CI, 27%-35%), with an adjusted OR (aOR) of 1.16 (95% CI, 0.88-1.53; P = .29). By contrast, during the first 12 months after bariatric surgery, the risk declined significantly (12%; 95% CI, 9%-15%; aOR, 0.35; 95% CI, 0.25-0.49; P < .001). Likewise, in the subsequent period of 13 to 24 months after bariatric surgery, the risk remained significantly low (13%; 95% CI, 11%-17%; aOR, 0.39; 95% CI, 0.28-0.55; P < .001).
The risk of an ED visit or hospitalization for AECOPD substantially decreased after bariatric surgery in patients who are obese. This observation suggests the effectiveness of substantial weight reduction on COPD morbidity.
肥胖在 COPD 患者中很常见，并且与 COPD 发病率的增加有关。然而，对于肥胖患者减轻体重对 COPD 相关结局的影响，知之甚少。
我们使用美国三个州（加利福尼亚州、佛罗里达州和内布拉斯加州）基于人群的急诊和住院患者样本，对 481 名接受过减重手术的肥胖（40-65 岁）COPD 成年人进行了一项自身对照病例系列研究。主要结局是 2005 年至 2011 年期间因 COPD 急性加重（AECOPD）而到急诊就诊或住院。我们使用手术前 13 至 24 个月（即参考期）的每个患者的风险来比较随后 12 个月期间的结局风险。
在减重手术前的 13 至 24 个月（即参考期）内，28%（95%CI，24%-32%）的患者因 AECOPD 到急诊就诊或住院。在随后的术前 12 个月期间，风险没有明显变化（31%；95%CI，27%-35%），调整后的比值比（aOR）为 1.16（95%CI，0.88-1.53；P=0.29）。相比之下，在减重手术后的前 12 个月内，风险显著下降（12%；95%CI，9%-15%；aOR，0.35；95%CI，0.25-0.49；P<0.001）。同样，在减重手术后的 13 至 24 个月期间，风险仍然较低（13%；95%CI，11%-17%；aOR，0.39；95%CI，0.28-0.55；P<0.001）。
肥胖患者减重手术后，因 AECOPD 而到急诊就诊或住院的风险显著降低。这一观察结果表明，体重显著减轻对 COPD 发病率有效。
