Kotlyarov Stanislav
Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia.
J Pers Med. 2023 Jul 24;13(7):1179. doi: 10.3390/jpm13071179.
(1) Background. Chronic obstructive pulmonary disease (COPD) has a heterogeneous natural history, manifested both in the variability of clinical features and in association with various comorbid pathologies. Atherosclerotic cardiovascular disease (ASCVD) is of great clinical importance and contributes significantly to the natural history and prognosis of COPD. The present study aimed to evaluate the nature of the comorbid course of COPD during a 15-year follow-up. (2) Methods: A total of 170 male COPD patients were included in this study. Spirometry values, symptom severity, presence of risk factors, and comorbidities were considered. Prognostic factors were evaluated using the Kaplan-Meier method. (3) Results: ASCVD was the most common comorbidity and the main cause of death in patients with COPD. Patients with comorbid COPD and ASCVD had more severe dyspnea, higher frequency of COPD exacerbations, and worse survival than patients without ASCVD ( < 0.01). Among patients with COPD, the risk of death from ASCVD was higher in those older than 60 years (OR 3.23, 95% CI [1.72, 6.07]), those with rapidly declining FEV1 (OR 4.35, 95% CI [2.28, 8.30]), those with more than two exacerbations per year (OR 3.21, 95% CI [1.71, 6.11]), and those with a pack year index greater than 30 (OR 2.75, 95% CI [1.38, 5.51]. High Charlson comorbidity index scores in patients with COPD were associated with a more severe disease course, including severity of dyspnea, frequency of exacerbations, and multivariate index scores. A high Charlson comorbidity index score was an adverse prognostic factor. (4) Conclusions: ASCVD influences the course of the disease and is a major cause of mortality in COPD patients.
(1) 背景。慢性阻塞性肺疾病（COPD）具有异质性自然病史，表现在临床特征的变异性以及与各种合并症病理的关联上。动脉粥样硬化性心血管疾病（ASCVD）具有重要临床意义，对COPD的自然病史和预后有显著影响。本研究旨在评估15年随访期间COPD合并症病程的性质。(2) 方法：本研究共纳入170例男性COPD患者。考虑了肺功能测定值、症状严重程度、危险因素的存在情况以及合并症。使用Kaplan-Meier方法评估预后因素。(3) 结果：ASCVD是COPD患者中最常见的合并症和主要死亡原因。合并COPD和ASCVD的患者比无ASCVD的患者有更严重的呼吸困难、更高的COPD急性加重频率和更差的生存率（P<0.01）。在COPD患者中，60岁以上者（OR 3.23，95%CI[1.72, 6.07]）、FEV1迅速下降者（OR 4.35，95%CI[2.28, 8.30]）、每年急性加重超过两次者（OR 3.21，95%CI[1.71, 6.11]）以及吸烟包年指数大于30者（OR 2.75，95%CI[1.38, 5.51]）死于ASCVD的风险更高。COPD患者的高Charlson合并症指数评分与更严重的疾病病程相关，包括呼吸困难的严重程度、急性加重频率和多变量指数评分。高Charlson合并症指数评分是一个不良预后因素。(4) 结论：ASCVD影响疾病病程，是COPD患者死亡的主要原因。
