Service de Physiologie-Explorations Fonctionnelles, Centre Hospitalier Universitaire Besançon, Besançon, France; Service de Pneumologie, Centre Hospitalier Universitaire Besançon, Besançon, France.
Service de Pneumologie et Soins Intensifs Respiratoires, Groupe Hospitalier Cochin, Site Val de Grâce, AP-HP, and Université Paris Descartes (EA2511), Sorbonne-Paris-Cité, Paris, France.
Chest. 2020 Apr;157(4):834-845. doi: 10.1016/j.chest.2019.11.002. Epub 2019 Nov 22.
The observation that COPD is an independent risk factor for cardiovascular disease (CVDs) comes from comparisons between smokers with COPD and smokers without COPD. The mechanisms that explain increased risk of CVD in patients with COPD are still unclear.
The goal of this study was to assess systemic arterial stiffness (a predictor of CVD mortality) and to evaluate its determinants in a group of patients with mild to moderate COPD secondary to organic dust exposure, tobacco smoking, or both.
Systemic arterial stiffness was assessed by using aortic pulse wave velocity (aPWV). Measurements were made in 142 patients with COPD and 155 healthy control subjects matched for age, sex, BMI, and tobacco smoking, exposed to tobacco smoking (n = 56/70 for COPD/control subjects, respectively), organic dusts (n = 44/48), or both (n = 42/37).
aPWV was higher in COPD than in healthy controls in subjects exposed to tobacco smoking and to both organic dusts and tobacco smoking. By contrast, among never smokers exposed to organic dusts, patients with COPD and matched control subjects had similar aPWV. Multivariate analysis of the 142 patients with COPD (exposed to tobacco smoking and/or to organic dusts) showed that tobacco smoking was associated with high aPWV. Moreover, soluble suppression of tumorigenicity 2, a marker of major cardiovascular events, was correlated with aPWV in these patients.
Analysis of an unselected group of patients with COPD with different causes suggests that: (1) COPD by itself is not sufficient to explain increased aPWV; and (2) tobacco smoking is a risk factor for elevated aPWV in COPD.
COPD 是心血管疾病（CVDs）的独立危险因素，这一观察结果来自于 COPD 吸烟者和非 COPD 吸烟者之间的比较。解释 COPD 患者 CVD 风险增加的机制仍不清楚。
本研究的目的是评估一组因有机粉尘暴露、吸烟或两者兼而有之而导致的轻度至中度 COPD 患者的系统性动脉僵硬（CVD 死亡率的预测指标）及其决定因素。
通过测量主动脉脉搏波速度（aPWV）来评估系统性动脉僵硬。在 142 名 COPD 患者和 155 名年龄、性别、BMI 和吸烟情况相匹配的健康对照者中进行了测量，其中分别有 56/70 名 COPD/对照者暴露于吸烟（n=56/70），44/48 名暴露于有机粉尘（n=44/48），42/37 名暴露于吸烟和有机粉尘（n=42/37）。
在暴露于吸烟和/或有机粉尘的 COPD 患者中，aPWV 高于健康对照者。相比之下，在从未吸烟但暴露于有机粉尘的患者中，COPD 患者和匹配的对照者的 aPWV 相似。对 142 名（暴露于吸烟和/或有机粉尘）COPD 患者的多变量分析显示，吸烟与高 aPWV 相关。此外，这些患者的可溶性肿瘤抑制物 2（主要心血管事件的标志物）与 aPWV 相关。
对具有不同病因的未选择的 COPD 患者进行分析表明：（1）COPD 本身不足以解释 aPWV 的增加；（2）吸烟是 COPD 患者 aPWV 升高的危险因素。
