右心衰竭作为慢性阻塞性肺疾病患者严重加重的危险因素：前瞻性队列研究
Right heart failure as a risk factor for severe exacerbation in patients with chronic obstructive pulmonary disease: Prospective cohort study.
作者信息
Orea-Tejeda Arturo, Navarrete-Peñaloza Ana Grecia, Verdeja-Vendrell Leslie, Jiménez-Cepeda Abril, González-Islas Dulce Gabriela, Hernández-Zenteno Rafael, Keirns-Davis Candace, Sánchez-Santillán Rocío, Velazquez-Montero Alejandra, Puentes Rodríguez Gerardo
机构信息
Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico.
Tabaquism and COPD Investigation Department, Instituto Nacional de Enfermedades Respiratorias 'Ismael Cosío Villegas', Mexico City, Mexico.
出版信息
Clin Respir J. 2018 Dec;12(12):2635-2641. doi: 10.1111/crj.12969. Epub 2018 Nov 11.
BACKGROUND
The prognosis in patients with Chronic Obstructive Pulmonary Disease (COPD) depends, in large part, on the frequency of exacerbations. Cardiovascular diseases, including heart failure (HF), are the risk factors for exacerbations. However, the importance of HF type over the exacerbations in COPD patients is unknown.
OBJECTIVE
To determine whether right heart failure (RHF) is an independent risk factor for severe exacerbations in patients with COPD.
METHODS
A prospective cohort study of 133 patients diagnosed with COPD with a follow-up period from 2010 to 2016. Patients with bronchial hyperreactivity, asthma, or pulmonary embolism were excluded.
RESULTS
The mean age was 74.7 ± 8.2 years and 43.6% were men, 69.9% had severe exacerbations during follow-up. Subjects with RHF had lower FEV (50.2 ± 19.9 vs 57.4 ± 16.9, P = .006) and greater incidence of stroke (15.4% vs 1.8%, P = .009) compared to those without RHF. Subjects with RHF were at higher risk of severe exacerbations (HR, 2.46; CI 95%, 1.32-4.58, P = .005) compared to those without RHF after adjusting for confounding variables.
CONCLUSION
In patients with COPD, RHF is an independent risk factor for suffering severe exacerbations.
背景
慢性阻塞性肺疾病（COPD）患者的预后在很大程度上取决于病情加重的频率。包括心力衰竭（HF）在内的心血管疾病是病情加重的危险因素。然而，心力衰竭类型对COPD患者病情加重的重要性尚不清楚。
目的
确定右心衰竭（RHF）是否为COPD患者严重病情加重的独立危险因素。
方法
对133例诊断为COPD的患者进行前瞻性队列研究，随访期为2010年至2016年。排除支气管高反应性、哮喘或肺栓塞患者。
结果
平均年龄为74.7±8.2岁，43.6%为男性，69.9%在随访期间出现严重病情加重。与无RHF的患者相比，有RHF的患者FEV较低（50.2±19.9 vs 57.4±16.9，P = 0.006），中风发生率更高（15.4% vs 1.8%，P = 0.009）。在调整混杂变量后，与无RHF的患者相比，有RHF的患者发生严重病情加重的风险更高（HR，2.46；95%CI，1.32 - 4.58，P = 0.005）。
结论
在COPD患者中，RHF是发生严重病情加重的独立危险因素。
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