慢性阻塞性肺疾病（COPD）与支气管扩张并存：COPD患者计算机断层扫描显示的主肺动脉与主动脉直径比值（PA:A）升高的一个危险因素。
Co-existence of COPD and bronchiectasis: a risk factor for a high ratio of main pulmonary artery to aorta diameter (PA:A) from computed tomography in COPD patients.
作者信息
Dou Shuang, Zheng Chunyan, Ji Xiuli, Wang Wei, Xie Mengshuang, Cui Liwei, Xiao Wei
机构信息
Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China.
Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2018 Feb 26;13:675-681. doi: 10.2147/COPD.S156126. eCollection 2018.
BACKGROUND
Pulmonary vascular disease, especially pulmonary hypertension, is an important complication of COPD. Bronchiectasis is considered not only a comorbidity of COPD, but also a risk factor for vascular diseases. The main pulmonary artery to aorta diameter ratio (PA:A ratio) has been found to be a reliable indicator of pulmonary vascular disease. It is hypothesized that the co-existence of COPD and bronchiectasis may be associated with relative pulmonary artery enlargement (PA:A ratio >1).
METHODS
This retrospective study enrolled COPD patients from 2012 through 2016. Demographic and clinical data were collected. Bhalla score was used to determine the severity of bronchiectasis. Patient characteristics were analyzed in two ways: the high (PA:A >1) and low (PA:A ≤1) ratio groups; and COPD with and without bronchiectasis groups. Logistic regression analysis was used to assess risk factors for high PA:A ratios.
RESULTS
In this study, 480 COPD patients were included, of whom 168 had radiographic bronchiectasis. Patients with pulmonary artery enlargement presented with poorer nutrition (albumin, 35.6±5.1 vs 38.3±4.9, <0.001), lower oxygen partial pressure (74.4±34.5 vs 81.3±25.4, <0.001), more severe airflow obstruction (FEV1.0, 0.9±0.5 vs 1.1±0.6, =0.004), and a higher frequency of bronchiectasis (60% vs 28.8%, <0.001) than patients in the low ratio group. Patients with both COPD and bronchiectasis had higher levels of systemic inflammation (erythrocyte sedimentation rate, <0.001 and fibrinogen, =0.006) and PA:A ratios (<0.001). A higher PA:A ratio was significantly closely correlated with a higher Bhalla score (r=0.412, <0.001). Patients with both COPD and bronchiectasis with high ratios presented higher levels of NT-proBNP (<0.001) and systolic pulmonary artery pressure (<0.001). Multiple logistic analyses have indicated that bronchiectasis is an independent risk factor for high PA:A ratios in COPD patients (OR =3.707; 95% CI =1.888-7.278; <0.001).
CONCLUSION
Bronchiectasis in COPD has been demonstrated to be independently associated with relative pulmonary artery enlargement.
背景
肺血管疾病，尤其是肺动脉高压，是慢性阻塞性肺疾病（COPD）的重要并发症。支气管扩张不仅被认为是COPD的一种合并症，也是血管疾病的一个危险因素。主肺动脉与主动脉直径比（PA:A比）已被发现是肺血管疾病的可靠指标。据推测，COPD和支气管扩张的共存可能与相对肺动脉增粗（PA:A比>1）有关。
方法
这项回顾性研究纳入了2012年至2016年的COPD患者。收集了人口统计学和临床数据。使用巴拉评分来确定支气管扩张的严重程度。患者特征通过两种方式进行分析：高（PA:A>1）、低（PA:A≤1）比值组；以及有、无支气管扩张的COPD组。采用逻辑回归分析评估PA:A比值高的危险因素。
结果
本研究纳入了480例COPD患者，其中168例有影像学支气管扩张。肺动脉增粗的患者营养状况较差（白蛋白，35.6±5.1对38.3±4.9，<0.001）、氧分压较低（74.4±34.5对81.3±25.4，<0.001）、气流阻塞更严重（FEV1.0，0.9±0.5对1.1±0.6，=0.004），且支气管扩张的发生率高于低比值组（60%对28.8%，<0.001）。同时患有COPD和支气管扩张的患者全身炎症水平（红细胞沉降率，<0.001；纤维蛋白原，=0.006）和PA:A比值（<0.001）更高。较高的PA:A比值与较高的巴拉评分显著密切相关（r=0.412，<0.001）。同时患有COPD和支气管扩张且比值高的患者NT-proBNP水平（<0.001）和收缩期肺动脉压（<0.001）更高。多项逻辑分析表明，支气管扩张是COPD患者PA:A比值高的独立危险因素（OR =3.707；95%CI =1.888-7.278；<0.001）。
结论
已证明COPD中的支气管扩张与相对肺动脉增粗独立相关。
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