老年慢性阻塞性肺病并发冠状动脉粥样硬化性心脏病的相关因素

摘要

目的：探讨老年慢性阻塞性肺病(COPD)并发冠状动脉粥样硬化性心脏病(CHD)的相关因素。方法收集大连大学附属中山医院2013年1月~2014年1月38例COPD患者(单纯组)及38例COPD并发CHD患者(合并组)的临床资料,同时选取40例健康者作为对照组,分析老年COPD患者并发CHD的相关因素。结果合并组与对照组比较,血小板、C反应蛋白(CRP)、一秒用力呼气容积占预计值的百分比(FEV1%)、白细胞数、中性粒细胞数、纤维蛋白原差异有统计学意义(P<0.01或P<0.05)；单纯组与对照组比较,白细胞数、纤维蛋白原、CRP及FEV1%的差异有统计学意义(P<0.01或P<0.05)；合并组与单纯组比较,白细胞数、中性粒细胞数、纤维蛋白原、血小板、CRP及FEV1%的差异有统计学意义(P<0.01或P<0.05)。 COPD合并CHD患者FEV1%与纤维蛋白原、CRP、白细胞总数、血小板呈负相关(r=-0.662、-0.718、-0.396、-0.345,P约0.01或P约0.05)。白细胞数、血小板数、纤维蛋白原水平、CRP水平是影响合并组患者FEV1%的不利因素。结论气流受限是CHD的危险因素,全身炎症与CHD有密切关系,临床上应加强对COPD患者相关心功能的监测,密切关注全身炎症相关指标,便于及时治疗,以减少致死率。%Objective To study the related factors in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with coronary heart disease (CHD). Methods From January 2013 to January 2014, in Zhongshan Hospital Affiliated to Dalian University, the clinical data of 38 patients with COPD and 38 patients of COPD with CHD were seleced and divided into pure group and combined group, and 40 healthy subjects were chosen as control group in the same period. The related factors in elderly patients with COPD complicated with CHD were discussed. Results Compared with control group, platelet count, CRP and FEV1%, blood cell count, neutrophil count, fibrinogen in the combined group had significant differences (P<0.01 or P<0.05);compared with control group, the differences of white blood cells count, fibrinogen, CRP, FEV1%in pure group were statistically significant (P<0.01 or P< 0.05); compared with pure group, the differences of white blood cells count, neutrophils count, fibrinogen, platelets count, CRP and FEV1%in the combined group were statistically significant (P< 0.01 or P<0.05). FEV1% of patients with COPD with CHD was negatively correlated with fibrinogen, CRP, white blood cells count, platelets count, (r = -0.662, -0.718,-0.396, -0.345, P< 0.01 or P< 0.05); white blood cell count, platelet count, fibrinogen level, CRP level were the ad-verse factors of affecting FEV1%in combined group. Conclusion The limited airflow is a risk factor for CHD, there is a close relationship between systemic inflammation and CHD, clinically relevant heart function in patients with COPD should be strengthened surveillance, pay close attention to related parameters of systemic inflammation, facilitate timely treatment, in order to reduce the fatality rate of cardiovascular disease.