慢性阻塞性肺疾病患者的颈动脉疾病和下肢动脉疾病
Carotid Artery Disease and Lower Extremities Artery Disease in Patients with Chronic Obstructive Pulmonary Disease.
作者信息
Buklioska-Ilievska Daniela, Minov Jordan, Kochovska-Kamchevska Nade, Gigovska Irena, Doneva Ana, Baloski Marjan
机构信息
Department of Pulmonology and Allergology, General Hospital "8th September", Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia.
出版信息
Open Access Maced J Med Sci. 2019 Jul 10;7(13):2102-2107. doi: 10.3889/oamjms.2019.576. eCollection 2019 Jul 15.
AIM
To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP).
METHODS
We performed a cross-sectional study including 60 patients with COPD (52 male, 8 female), aged 40 to 80 years, initially diagnosed according to the actual criteria. Also, 30 subjects in whom COPD was excluded, matched to COPD patients by sex, age, body mass index and smoking status, served as controls. All study subjects completed questionnaire and underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray), angiological evaluation by Doppler ultrasonography and measurement of serum CRP level.
RESULTS
We found a statistically significant difference between the frequency of carotid plaques in COPD patients as compared to their frequency in controls (65% vs 30%; P = 0.002). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.7 ± 0.2; P = 0.049). IMT value in COPD patients with CAD was significantly related to the degree of airflow limitation, i.e. to the degree of FEV1 decline (P = 0.000), as well as to the serum CRP level (P = 0.001). We found a statistically significant difference between the frequency of COPD patients with LEAD as compared to the frequency of LEAD in controls (78.3% vs 43.3%; P = 0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in the stages I, IIA and IIB (53.3%, 30% and 16.7%, respectively), whereas all controls with LEAD were categorized in the Fontaine stage I. Among COPD patients with LEAD there was significant association between disease severity and clinical manifestations due to the vascular changes (P = 0.001) and serum CRP level (P = 0.001).
CONCLUSION
Our findings suggest higher prevalence and higher severity of vascular changes in COPD patients as compared to their prevalence and severity in non-COPD subjects. Prevalence and severity of vascular changes in COPD patients were significantly related to the severity of airflow limitation and serum CRP levels.
目的
评估慢性阻塞性肺疾病（COPD）患者颈动脉疾病（CAD）和下肢动脉疾病（LEAD）的发生率，以及它们与气流受限严重程度和C反应蛋白（CRP）水平的关系。
方法
我们进行了一项横断面研究，纳入60例COPD患者（男52例，女8例），年龄40至80岁，最初根据现行标准诊断。另外，30例排除COPD的受试者，根据性别、年龄、体重指数和吸烟状况与COPD患者匹配，作为对照。所有研究对象均完成问卷并接受肺部评估（呼吸困难严重程度评估、基线和支气管扩张剂后肺功能测定、气体分析和胸部X线检查）、通过多普勒超声进行血管评估以及测定血清CRP水平。
结果
我们发现，COPD患者颈动脉斑块的发生率与对照组相比有统计学显著差异（65%对30%；P = 0.002）。患有CAD的COPD患者内膜中层厚度（IMT）的平均值显著高于对照组（0.8±0.2对0.7±0.2；P = 0.049）。患有CAD的COPD患者的IMT值与气流受限程度显著相关，即与FEV1下降程度相关（P = 0.000），也与血清CRP水平相关（P = 0.001）。我们发现，患有LEAD的COPD患者的发生率与对照组中LEAD的发生率相比有统计学显著差异（78.3%对43.3%；P = 0.001）。根据Fontaine分类，患有LEAD的COPD患者分别被归类为I期、IIA期和IIB期（分别为53.3%、30%和16.7%），而所有患有LEAD的对照均被归类为Fontaine I期。在患有LEAD的COPD患者中，疾病严重程度与血管变化引起的临床表现之间存在显著关联（P = 0.001），与血清CRP水平也存在显著关联（P = 0.001）。
结论
我们的研究结果表明，与非COPD受试者相比，COPD患者血管变化的患病率和严重程度更高。COPD患者血管变化的患病率和严重程度与气流受限严重程度和血清CRP水平显著相关。
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