Børvik Trond, Evensen Line H, Morelli Vania M, Melbye Hasse, Brækkan Sigrid K, Hansen John-Bjarne
K.G. Jebsen Thrombosis Research and Expertise Centre (TREC) Department of Clinical Medicine UiT-The Arctic University of Norway Tromsø Norway.
Division of Internal Medicine University Hospital of North Norway Tromsø Norway.
Res Pract Thromb Haemost. 2020 Jan 9;4(2):255-262. doi: 10.1002/rth2.12299. eCollection 2020 Feb.
Chronic obstructive pulmonary disease (COPD) is associated with risk of venous thromboembolism (VTE). It remains unknown whether individual respiratory symptoms and lowered oxygen saturation (SpO), individually and in combination with COPD, affect the risk of VTE.
To investigate whether measures of respiratory impairments including respiratory symptoms and SpO, individually and combined with COPD, were associated with an increased risk of VTE.
Spirometry, SpO, and self-reported respiratory symptoms were collected in 8686 participants from the fifth (2001-2002) and sixth (2007-2008) surveys of the Tromsø Study. Incident VTE events were registered from the date of inclusion to December 31, 2016. Cox regression models with exposures and confounders as time-varying covariates (for repeated measurements) were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE.
During a median follow-up of 9.1 years, 330 participants developed incident VTE. Subjects with SpO ≤ 96% (lowest 20th percentile) had a 1.5-fold higher risk of VTE (adjusted HR, 1.48; 95% CI, 1.13-1.93) compared with those with SpO ≥ 98%. Severe respiratory symptoms (dyspnea, cough, and phlegm) were associated with a 1.4- to 2.0-fold higher risk of VTE compared with no such symptoms. COPD, combined with respiratory symptoms or lowered SpO, had an additive effect on the VTE risk.
Lowered SpO and severe respiratory symptoms were associated with increased VTE risk. COPD combined with respiratory impairments had an additive effect on VTE risk, and may suggest particular attention on VTE preventive strategies in COPD patients with respiratory impairments.
慢性阻塞性肺疾病（COPD）与静脉血栓栓塞症（VTE）风险相关。目前尚不清楚个体的呼吸道症状和氧饱和度降低（SpO）单独以及与COPD共同作用时，是否会影响VTE风险。
探讨包括呼吸道症状和SpO在内的呼吸功能损害指标单独以及与COPD共同作用时，是否与VTE风险增加相关。
在特罗姆瑟研究的第五次（2001 - 2002年）和第六次（2007 - 2008年）调查中，收集了8686名参与者的肺活量测定、SpO以及自我报告的呼吸道症状。从纳入日期至2016年12月31日记录新发VTE事件。使用将暴露因素和混杂因素作为随时间变化的协变量（用于重复测量）的Cox回归模型来估计VTE的风险比（HRs）及其95%置信区间（CIs）。
在中位随访9.1年期间，330名参与者发生了新发VTE。SpO≤96%（最低第20百分位数）的受试者发生VTE的风险比SpO≥98%的受试者高1.5倍（校正HR，1.48；95%CI，1.13 - 1.93）。与无此类症状相比，严重呼吸道症状（呼吸困难、咳嗽和咳痰）与VTE风险高1.4至2.0倍相关。COPD与呼吸道症状或SpO降低共同作用时，对VTE风险有相加效应。
SpO降低和严重呼吸道症状与VTE风险增加相关。COPD与呼吸功能损害共同作用时对VTE风险有相加效应，这可能提示对有呼吸功能损害的COPD患者的VTE预防策略应给予特别关注。
