哮喘-COPD 重叠患者与单纯 COPD 患者心境障碍风险的差异：韩国一项全国基于人群的回顾性队列研究。
Differences in the risk of mood disorders in patients with asthma-COPD overlap and in patients with COPD alone: a nationwide population-based retrospective cohort study in Korea.
机构信息
School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea.
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Respir Res. 2019 Apr 30;20(1):80. doi: 10.1186/s12931-019-1039-5.
BACKGROUND
Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), little is known about the estimates of their incidence in patients with asthma-COPD overlap (ACO), which has been described and acknowledged as a distinct clinical entity. We aimed to estimate the risk of depression and anxiety among patients with ACO and compare it with the risk among those with COPD alone in the general population.
METHODS
We conducted a nationwide population-based retrospective cohort study using the Korean National Sample Cohort database between 1 January, 2002, and 31 December, 2013. Patients who were diagnosed with COPD (International Classification of Diseases, 10th revision [ICD-10] codes J42-J44) at least twice and prescribed COPD medications at least once between 2003 and 2011 were classified into two categories: patients who were diagnosed with asthma (ICD-10 codes J45-J46) more than twice and at least once prescribed asthma medications comprised the ACO group, and the remaining COPD patients comprised the COPD alone group. Patients who had been diagnosed with depression or anxiety within a year before the index date were excluded. We defined the outcome as time to first diagnosis with depression and anxiety. Matched Cox regression models were used to compare the risk of depression and anxiety among patients with ACO and patients with COPD alone after propensity score matching with a 1:1 ratio.
RESULTS
After propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 15,644 patients. The risk of depression during the entire study period was higher for patients with ACO than for patients with COPD alone (adjusted hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; P value = 0.0039), with an elevated risk in patients aged 40-64 years (1.21; 1.10-1.34; 0.0001) and in women (1.18; 1.07-1.29; 0.0005). The risk of anxiety was higher for patients with ACO than for patients with COPD alone (1.06; 1.01-1.12; 0.0272), with a higher risk in patients aged 40-64 years (1.08; 1.00-1.17; 0.0392); however, the risk was not significant when stratified by sex.
CONCLUSIONS
This population-based study revealed a higher incidence of depression and anxiety in patients with ACO than in patients with COPD alone.
背景
尽管焦虑和抑郁的感觉在慢性阻塞性肺疾病（COPD）患者中很常见，但对于哮喘-COPD 重叠（ACO）患者中这些疾病的发生率的估计却知之甚少，ACO 已被描述并被认为是一种独特的临床实体。我们旨在估计 ACO 患者中抑郁和焦虑的风险，并将其与普通人群中 COPD 患者的风险进行比较。
方法
我们使用 2002 年 1 月 1 日至 2013 年 12 月 31 日期间的韩国国家抽样队列数据库，进行了一项全国性基于人群的回顾性队列研究。在 2003 年至 2011 年期间，至少两次被诊断为 COPD（国际疾病分类，第 10 版 [ICD-10] 代码 J42-J44）并至少一次开处 COPD 药物的患者被分为两类：至少两次被诊断为哮喘（ICD-10 代码 J45-J46）并至少一次开处哮喘药物的患者为 ACO 组，其余的 COPD 患者为 COPD 单独组。在指数日期之前的一年中被诊断患有抑郁症或焦虑症的患者被排除在外。我们将结局定义为首次诊断为抑郁症和焦虑症的时间。使用匹配的 Cox 回归模型比较 ACO 患者和 COPD 单独患者的抑郁和焦虑风险，在倾向评分匹配时采用 1:1 比例。
结果
在进行倾向评分估计和 1:1 比例匹配后，分析中使用的队列包括 15644 名患者。在整个研究期间，ACO 患者的抑郁风险高于 COPD 单独患者（调整后的危险比，1.10；95%置信区间，1.03-1.18；P 值=0.0039），40-64 岁患者（1.21；1.10-1.34；0.0001）和女性患者（1.18；1.07-1.29；0.0005）的风险升高。ACO 患者的焦虑风险高于 COPD 单独患者（1.06；1.01-1.12；0.0272），40-64 岁患者的风险更高（1.08；1.00-1.17；0.0392）；然而，按性别分层时，风险不显著。
结论
这项基于人群的研究显示，ACO 患者的抑郁和焦虑发生率高于 COPD 单独患者。
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