心血管合并症对慢阻肺患者急性加重及死亡率影响的1年随访观察

目的探讨心血管合并症对慢性阻塞性肺疾病(简称慢阻肺)患者1年内急性加重及死亡率的影响。方法本研究入选600例C级、D级慢阻肺患者,其中无心血管合并症慢阻肺患者(A组)167例,合并心血管疾病慢阻肺患者(B组)433例(其中心力衰竭亚组98例、冠心病亚组142例、心律失常亚组115例、高血压亚组78例),两组患者均随访1年,随访期间每3月复查肺功能、动脉血气、心脏彩超、血清脑钠肽(brain natriuretic peptide,BNP)。结果 B组患者1年内平均急性加重次数(4.51±0.75)次]明显多于A组患者(2.68±0.45)次],差异有统计学意义(P0.05);B组患者1年内死亡率为8.8%,明显高于A组患者的3.6%,差异有统计学意义(P0.05)。B组心力衰竭亚组、冠心病亚组1年内急性加重次数及死亡率均明显高于A组及B组心律失常亚组、高血压亚组(P均0.05)。随访1年后,A组患者及B组各亚组患者FEV1均明显下降(P0.05);B组心力衰竭亚组患者血清BNP浓度、Pa CO2、肺动脉收缩压明显升高、而左室EF值、Pa O2明显下降(P0.05);B组冠心病亚组患者血BNP浓度明显升高(P0.05);B组高血压亚组患者平均动脉压无明显变化。结论心血管合并症明显增加慢阻肺患者1年内急性加重次数及死亡率,心力衰竭、冠心病是导致慢阻肺患者死亡率升高、急性加重次数增加的两个重要原因。

1-year follow-up on how cardiovascular complications influencing acute exacerbation and mortality of pa-tients with chronic obstructive pulmonary disease

Objective To study the influence of cardiovascular complications on acute exacerbation and mor-tality of patients with chronic obstructive pulmonary disease ( COPD) within one year. Methods 600 COPD patients at grade C and D were divided into the group A (167 cases without cardiovascular complications) and the group B (433 cases with cardiovascular diseases). The group B included 98 cases of heart failure, 142 cases of coronary heart disease ( CHD) , 115 cases of arrhythmia and 78 cases of hypertension. All subjects were followed up once in every three month through the reexamination of pulmonary function test, arterial blood gas analysis, Doppler echocardio-graphy and serum BNP for one year. Results The average times of exacerbation was (4. 51 ± 0. 75) in the group B and (2. 68 ±0. 45) in the group A within 1 year (P<0. 05). The mortality was 8. 8% in the group B, which was statistically higher than that in the group A ( 3. 6%) within 1 year ( P<0. 05 ) . The average times of exacerbation and mortality of the coronary heart disease subgroup and the heart failure group were statistically higher than those of the group A and the arrhythmia subgroup and the hypertension subgroup within 1 year ( P<0. 05 ) . After a year of follow-up, the FEV1 of all subjects significantly decreased (P<0. 05), meanwhile, the serum BNP, PaCO2 and pul-monary arterial systolic pressure significantly increased while the EF value of left ventricle and PaO2 significantly de-creased in the heart failure subgroup(P<0. 05). At the same time, the serum BNP of the CHD subgroup increased significantly (P<0. 05), while there was no obvious change for the mean arterial pressure in the hypertension sub-group. Conclusion The times of exacerbation and mortality within one year significantly increase in COPD patients with cardiovascular complications in which heart failure and coronary heart disease are two major reasons.