[老年重度和极重度慢性阻塞性肺疾病合并慢性肾脏病早期患者发生主要心血管事件的预测因素]

[Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease].

作者信息

Bolotova E V, Yavlyanskaya V V, Dudnikova A V

机构信息

Kuban State Medical University, Sedina st. 4, Krasnodar, Russia 350063.

State Budgetary Institution of Health Care, Territorial Clinical Hospital #2, Krasnykh Partizan 6, k. 2, Krasnodar, Russia 350012.

出版信息

Kardiologiia. 2019 Apr 13;59(3S):52-60. doi: 10.18087/cardio.2539.

DOI:10.18087/cardio.2539

PMID:30990153

Abstract

AIM

To study the structure of major cardiovascular events (MCVE) and to identify their independent predictors in elderly patients with severe and extremely severe chronic obstructive pulmonary disease (COPD) in combination with early stages of chronic kidney disease (CKD).

MATERIALS AND METHODS

The study included 172 elderly patients with stage 3-4 COPD associated with stage 1-2 CKD. Initially, risk factors for MCVE were identified and levels of vitamin D (25 (ОН) D) were measured for all patients. In 12 months, MCVE anamnesis was collected, and patients were divided into two groups with and without MCVE during the observation period. The risk factors for MCVE, which were significantly different between the two groups according to results of a one-way analysis, were successively included into a logistic regression for identifying independent predictors of MCVE. A ROC analysis was performed for the identified variables to identify a predictive cut-off point.

RESULTS

21 MCVEs were observed in 8.7% (15) patients. Heart rhythm disorders (HRD) not reversed at the prehospital stage were observed in 38.1% patients; acute cerebrovascular disease and transient ischemic attack - in 23.8%, acute coronary syndrome - in 23.8%, and pulmonary thromboembolism (PTE) - in 14.3%. Two MCVEs, namely, a combination of HRD not reversed at the prehospital stage and PTE, were observed in 3 (20%) patients. The ROC analysis showed that the incidence of COPD exacerbation for the previous 12 months >3 had the highest predictive value for the 12-month risk of MCVE in patients with COPD associated with early CKD (95% CI, 0.823-0.925, р=0.001). A total PROCAM score <50 (95% CI, 0.882-0.964, р=0.001); GFR ≥80 ml/min/1.73 m2 (95% CI, 0.750-0.870, р=0.001); and a level of vitamin D ≥33 ng/ml (95% CI, 0.730-0.855, р=0.001) reduced the risk for MCVE.

CONCLUSIONS

In elderly patients with grade 3-4 COPD associated with stage 1-2 CKD, the development of MCVE within 12 months was determined by the incidence of COPD exacerbations for the previous 12 months >3 while a total PROCAM score <50, GFR >80 ml/min/1.73 m3 , and levels of vitamin D >33 ng/ml reduced the risk of MCVE in these patients.

摘要

目的

研究老年重度和极重度慢性阻塞性肺疾病（COPD）合并慢性肾脏病（CKD）早期患者的主要心血管事件（MCVE）结构，并确定其独立预测因素。

材料与方法

本研究纳入172例3-4期COPD合并1-2期CKD的老年患者。首先，确定MCVE的危险因素，并测量所有患者的维生素D（25（OH）D）水平。12个月时，收集MCVE病史，并将患者分为观察期内发生MCVE和未发生MCVE的两组。根据单因素分析结果，将两组间有显著差异的MCVE危险因素依次纳入逻辑回归，以确定MCVE的独立预测因素。对所确定的变量进行ROC分析，以确定预测切点。

结果

8.7%（15）的患者发生了21次MCVE。38.1%的患者存在院前阶段未逆转的心律失常（HRD）；急性脑血管病和短暂性脑缺血发作-23.8%，急性冠状动脉综合征-23.8%，肺血栓栓塞症（PTE）-14.3%。3例（20%）患者发生了2次MCVE，即院前阶段未逆转的HRD与PTE的组合。ROC分析显示，既往12个月COPD急性加重发生率>3对合并早期CKD的COPD患者12个月MCVE风险的预测价值最高（95%CI，0.823-0.925，p=0.001）。总PROCAM评分<50（95%CI，0.882-0.964，p=0.001）；肾小球滤过率（GFR）≥80ml/min/1.73m2（95%CI，0.750-0.870，p=0.001）；维生素D水平≥33ng/ml（95%CI，0.730-0.855，p=0.001）可降低MCVE风险。