a Department of Research and Education , Ciro , Horn , Netherlands.
b Environmental Risk and Health Unit , Flemish Institute for Technological Research (VITO) , Mol , Belgium.
Expert Rev Respir Med. 2017 Dec;11(12):1021-1031. doi: 10.1080/17476348.2017.1389277. Epub 2017 Oct 12.
Cardiovascular disease is an important cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD). Endothelial function may be involved in the pathogenesis of cardiovascular disease. In contrast to the attention given to pulmonary endothelial dysfunction, little is known about peripheral vascular changes in COPD. Therefore, we reviewed the literature on peripheral endothelial function in COPD.
Databases were screened for studies using ultrasound-based flow-mediated dilation (FMD), the reference method for assessing peripheral endothelial function, in stable COPD patients. Pooled effect sizes were calculated using random effects model.
17 studies were identified, with a total of 1228 participants (724 COPD patients; 504 controls). Pooled analysis demonstrated an impaired endothelial-dependent FMD (-3.22%; 95% confidence interval (CI) -4.74 to -1.69; p < 0.001; I = 96%) and endothelial-independent FMD (-2.86%; 95%CI -5.63 to -0.09; p = 0.04; I = 83%) in COPD patients when compared with smoking and non-smoking controls.
This review provides evidence for impaired peripheral endothelial function in COPD. Since impaired endothelial function may contribute to cardiovascular morbidity, a more comprehensive cardiovascular phenotyping is considered important in COPD to address cardiovascular risk. A high frequency of cardiovascular comorbidity is observed in COPD patients, and therefore well-controlled, larger studies that investigate endothelial function in COPD patients are recommended.
心血管疾病是慢性阻塞性肺疾病（COPD）发病率和死亡率的重要原因。内皮功能可能与心血管疾病的发病机制有关。与对肺内皮功能障碍的关注相比，COPD 外周血管变化知之甚少。因此，我们回顾了 COPD 外周内皮功能的文献。
使用超声血流介导扩张（FMD）筛选数据库，这是评估外周内皮功能的参考方法，对稳定期 COPD 患者进行研究。使用随机效应模型计算汇总效应量。
确定了 17 项研究，共有 1228 名参与者（724 名 COPD 患者；504 名对照者）。荟萃分析表明，COPD 患者的内皮依赖性 FMD 受损（-3.22%；95%置信区间（CI）-4.74 至-1.69；p<0.001；I=96%）和内皮非依赖性 FMD 受损（-2.86%；95%CI-5.63 至-0.09；p=0.04；I=83%）与吸烟和非吸烟对照组相比。
本综述提供了 COPD 外周内皮功能受损的证据。由于内皮功能障碍可能导致心血管发病率增加，因此在 COPD 中更全面的心血管表型被认为很重要，以解决心血管风险。在 COPD 患者中观察到心血管合并症的频率较高，因此建议进行频率更高、规模更大的研究，以调查 COPD 患者的内皮功能。
