慢性阻塞性肺疾病与冠状动脉粥样硬化的相关性分析被引量：2

Relationship between chronic obstructive pulmonary disease and coronary atherosclerotic

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摘要目的分析冠状动脉粥样硬化患者与冠状动脉粥样硬化合并COPD患者外周血液指标、肺功能、Gensini评分的差异性，探讨cOPD对冠状动脉粥样硬化的影响。方法通过冠状动脉造影和肺功能检查，将62例研究对象分为正常对照组16例、冠状动脉粥样硬化组20例，冠状动脉粥样硬化合并COPD组26例。记录所有研究对象外周血白细胞、中性粒细胞、单核细胞、淋巴细胞、血小板计数，血清总胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白、ApoA—I、ApoB，血浆纤维蛋白原（Fbg），空腹血糖、肺功能（FEV1％pred、FEV1/FVC比值）及冠状动脉造影术后Gensini评分。按COPD的严重程度分为轻度6例、中度16例、重度以上4例。应用SPSS17．0统计软件，分析冠状动脉粥样硬化合并COPD组与冠状动脉粥样硬化组血液指标及FEV1％pred的差异性；分析Gensini评分在两组间的差异性及与FEV1％pred、血液指标、COPD严重程度的相关性。逐步回归分析上述指标对Gensini评分的影响。结果与正常对照组比较，冠状动脉粥样硬化组及冠状动脉粥样硬化合并COPD组外周血白细胞、中性粒细胞计数明显升高，且差异有统计学意义（P〈0．05），FEV1％pred均明显降低，且差异有统计学意义（P〈0．05）。冠状动脉粥样硬化合并COPD组与冠状动脉粥样硬化组比较，外周血白细胞、中性粒细胞、单核细胞计数均明显升高，差异有统计学意义（P〈0．05），FEV1％pred显著降低（P〈0．05），Gensini评分明显升高（P〈0．05）。冠状动脉粥样硬化合并COPD组，Gensini评分与白细胞计数（r=0．438，P〈0．05）及单核细胞计数（r=0．421，P〈0．05）呈正相关性；Gensini评分与FEV1％pred呈负相关性（r=0．668，P〈0．05）。多元回归分析仅FEV1％pred与Gensini评分具有独立相关性，（Y=83．535—0．675×FEV1％pred）。结论COPD患者的气流受限是冠状动脉粥样硬化的危险因素，可能与COPD的炎症反应加重冠状动脉粥样硬化有关。 Objective By studying the variability in lung function, peripheral blood indicators and Gensini score between chronic obstructive pulmonary disease （COPD） combined coronary atherosclerotic patients,and patients which have coronary atherosclerotic without COPD, this article is to investigate the the impact of COPD on coronary atherosclerotie. Methods Coronary angiography and spirometry were performed in 62 subjects. Accordingly,we divided the all subjects into three groups,including 20 COPD- free patients with coronary atherosclerotic,26 COPD patients which have coronary atheroselerotic and 16 healthy controls,and determined levels of total serum cholesterol, high-density lipoprotein （HDL）, low- density lipoprotein,triglyceride, and apolipoprotein AI and B, levels of fasting plasma glucose, levels of plasma fibrinogen, levels of peripheral blood leukocyte, neutrophil, monocyte, lymphocyte and platelet counts,among them Inflammatory indicators include： plasma fibrinogen; platelet leukocyte, neutrophil, monocyte,and lymphocyte counts. Lung function indicators include： the percentage of predicted forcedexpiratory volume in 1 second （FEV1 % pred）, FEV1/FVC （forced vital capacity, FVC） ratio. COPD patients combined coronary atherosclerotic were classified as mild in 6 cases,moderate in 16 cases, severe or more in 4 cases by COPD severity. The Gensini score is also needed to be recorded after coronary angiography, to evaluate the severity of coronary atherosclerotic. By SPSS software, variability was assessed among three groups in peripheral blood indicators, lung function indicators and Gensini score, relationships were assessed between the Gensini score and Lung function indicators,the Gensini score and peripheral blood indicators. Stepwise regression analysis： the impact of indicators which had the relationship with Gensini score on Gensini score. Results Compared with normal control group,peripheral blood leukocyte, neutrophil, and monocyte count was respectively significantly higher, （ P 〈 0.05）, FEV1 %pred decreased significantly （ P 〈0.05） in COPD combined coronary atherosclerotic group; The coronary atheroselerotic group had higher leukocytes, neutrophils than normal control group （ P 〈0.05）, and had lower FEV1% pred. Compared with coronary atherosclerotic group,in COPD combined coronary atherosclerotic group peripheral blood leukocyte, neutrophil, and monocyte count was respectively significantly higher （ P 〈 0.05）, FEV1% pred decreased significantly （ P〈 0.05 ）, and Gensini score was significantly higher （ P 〈0.05）. In COPD combined coronary atherosclerotic group, Gensini score was positively correlated with peripheral blood leukocyte and monocyte count （respectively, r = 0. 438, P 〈 0.05 ; r =0. 421, P 〈 0.05） ; Gensini score was negatively correlated with FEV1% pred （respectively, r =-0. 668, P 〈0.05）. By multie regression analysis only FEV1% pred was correlated with Gensini sore （Y=83. 535-0. 675 ）〈 FEV1%pred）. Conclusions Airflow limitation is a risk factor for coronary atherosclerosis. The reason is that Inflammatory reaction of COPD may worsen the degree of coronary atherosclerosis.

作者张慧朱宁王镇山

机构地区瓦房店市中心医院呼吸内科大连医科大学附属第二医院心内科大连医科大学附属第二医院呼吸内科

出处《国际呼吸杂志》 2014年第11期815-820,共6页 International Journal of Respiration

关键词慢性阻塞性肺疾病冠状动脉粥样硬化 Chronic obstructive pulmonary disease Coronary atherosclerosis

分类号 R563.9 [医药卫生—呼吸系统] R543.3 [医药卫生—心血管疾病]

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