CAJ | 학술논문

目的探讨老年慢性阻塞性肺疾病(COPD)患者气道阻塞严重程度与动脉硬化的关系. 方法收集2008年1月至2012年10月诊断为COPD的老年患者81例,根据第1秒用力呼气容积(FEV1)占预计值百分比≥50％分为轻/中度患者(51例),FEV1占预计值百分比＜50％为重度患者(30例).所有患者均行肱踝脉搏波传导速度(baPWV)检查作为反映外周动脉硬化的指标,行Holter检查计算24 h平均心率,并收集患者年龄、性别、体质指数(BMI)、吸烟史、既往病史、合并用药等基本资料以及血脂、血糖、动脉血氧分压(PaO2)、血清超敏C反应蛋白(hs-CRP)进行两组间比较. 结果两组患者年龄、性别、吸烟情况、患糖尿病、高血压、冠心病、脂代谢紊乱的比例差异均无统计学意义;重度组患者BMI小于轻/中度组患者[(22.8±4.2) kg/m2比(25.3±3.2) kg/m2,t=3.02,P=0.003],24 h平均心率高于轻/中度组患者[(77.4±12.7)次/min比(70.8±9.6)次/min,t=-2.60,P=0.011],PaO2低于轻/中度组患者[(74.6±13.0) mmHg比(82.4±13.1) mmHg,t=2.46,P=0.017].所有患者中有76例(93.8％)外周动脉硬化程度增加(baPWV＞14.00 m/s),重度组baPWV高于轻/中度组患者[(20.77±3.71) m/s比(18.84±4.11)m/s,t=-2.11,P=0.038].重度组患者hs-CRP水平高于轻/中度组患者[(6.51±5.66)mg/L比(3.27±3.34)mg/L,t=-2.66,P=0.009]. 结论 COPD患者合并动脉硬化发病率高,且气道阻塞程度越重,外周动脉硬化越严重,可能与COPD患者慢性炎性状态、长期低氧和交感神经过度激活等因素相关.
목적 탐토노년만성조새성폐질병(COPD)환자기도조새엄중정도여동맥경화적관계. 방법 수집2008년1월지2012년10월진단위COPD적노년환자81례,근거제1초용력호기용적(FEV1)점예계치백분비≥50％분위경/중도환자(51례),FEV1점예계치백분비＜50％위중도환자(30례).소유환자균행굉과맥박파전도속도(baPWV)검사작위반영외주동맥경화적지표,행Holter검사계산24 h평균심솔,병수집환자년령、성별、체질지수(BMI)、흡연사、기왕병사、합병용약등기본자료이급혈지、혈당、동맥혈양분압(PaO2)、혈청초민C반응단백(hs-CRP)진행량조간비교. 결과 량조환자년령、성별、흡연정황、환당뇨병、고혈압、관심병、지대사문란적비례차이균무통계학의의;중도조환자BMI소우경/중도조환자[(22.8±4.2) kg/m2비(25.3±3.2) kg/m2,t=3.02,P=0.003],24 h평균심솔고우경/중도조환자[(77.4±12.7)차/min비(70.8±9.6)차/min,t=-2.60,P=0.011],PaO2저우경/중도조환자[(74.6±13.0) mmHg비(82.4±13.1) mmHg,t=2.46,P=0.017].소유환자중유76례(93.8％)외주동맥경화정도증가(baPWV＞14.00 m/s),중도조baPWV고우경/중도조환자[(20.77±3.71) m/s비(18.84±4.11)m/s,t=-2.11,P=0.038].중도조환자hs-CRP수평고우경/중도조환자[(6.51±5.66)mg/L비(3.27±3.34)mg/L,t=-2.66,P=0.009]. 결론 COPD환자합병동맥경화발병솔고,차기도조새정도월중,외주동맥경화월엄중,가능여COPD환자만성염성상태、장기저양화교감신경과도격활등인소상관.
Objective To evaluate the relationship between severity of airway obstruction and peripheral arterial stiffness in patients with chronic obstructive pulmonary disease (COPD).Methods 81 COPD patients [aged (78.32 ± 6.98)yrs,73 males,8 females] from Jan 2008 to Oct 2012 were enrolledin Geriatric Department of Peking University First Hospital.All patients underwent spirometry and Holter evaluation,while age,sex,BMI,smoking pack-years,medical history,blood levels of lipid profiles,glucose,high sensitivity C reactive protein (hsCRP)and arterial oxygen pressure (PaO2)were recorded.The severity of airway obstruction was evaluated by spirometry.The patients were divided into two groups:mild/moderate group [forced expiratory volume in one second (FEV1％) predicted ≥ 50 ％,n=51] and severe group (FEV1％ predicted ＜ 50％,n=30).24-hour average heart rate (HR)was assessed by holter.Arterial stiffness was assessed by the brachial ankle pulse wave velocity (baPWV).The baPWV increment was considered to be a direct witness of arterial stiffness increase.Blood levels of lipid profiles,glucose,arterial oxygen pressure (PaO2)and hsCRP were compared between the two groups.Results Age,gender,smoking index,medical history of the two groups were matched.BMI was less in severe group than in mild/moderate group [(22.8± 4.2) kg/m2 vs.(25.3± 3.2) kg/m2,t=3.017,P＜0.05].24-hour average HR was higher in severe group than in mild/moderate group [(77.4± 12.7)bpm vs.(70.8± 9.6)bpm,t=-2.602,P＜0.05].The PaO2 was lower in severe group than in mild/moderate group [(74.6±13.0)mmHg vs.(82.4± 13.1)mmHg,t=2.456,P＜0.05].There were no differences in blood lipid profile and glucose levels between the two groups.76 patients (93.4％)were detected with peripheral arterial stiffness by baPWV＞14.00 m/s.baPWV was significantly increased in severe group as compared with mild/moderate group [(20.77 ± 3.71) m/s vs.(18.84 ± 1.88) m/s,t=-2.109,P＜0.05].hsCRP was significantly higher in severe group than in mild/moderate group [[(6.51±5.66)mg/L vs.(3.27±3.34)mg/L,t=-2.658,P＜0.01].Conclusions The morbidity of peripheral arterial stiffness is increased in patients with COPD.Progression of arterial stiffness is related to the severity of airway obstruction,which may be related to chronic inflammation,hypoxia,or excessive sympathetic activation.