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COPD 2016:我们是否应该将慢性阻塞性肺疾病作为心血管疾病来治疗?威廉·麦克尼_英国爱丁堡大学

摘要

慢性阻塞性肺病(COPD)的特征是气流持续受限，通常是进行性的，并与肺部对有害颗粒或气体的异常炎症反应有关。COPD的自然病程因系统性后果和合并症的发展而复杂化，这些合并症具有重要的预后意义，影响发病率和死亡率。心血管合并症是影响COPD患者最常见的合并症之一，COPD被认为是动脉粥样硬化及其引起的心血管并发症发展的危险因素。用力呼气动作(FEV1)第一秒的呼气量也被认为是COPD心血管并发症的独立预测因子。即使FEV1的适度降低也会使心血管事件的发病和死亡风险增加2至3倍。COPD与几种心血管疾病(如吸烟)有共同的危险因素，但有几种机制与COPD心血管共病的患病率增加有关，包括系统性炎症和衰老机制。COPD患者的心血管合并症没有得到充分的认识和治疗，应根据标准指南积极调查和治疗。本综述将讨论COPD患者心血管合并症发生率的增加和预后意义。COPD患者心血管合并症的发病机制也将被检查，COPD患者心血管合并症的管理也将被讨论。慢性阻塞性肺病是全球第四大死亡原因。 However, in the United Kingdom and the United States, more COPD patients die from cardiovascular causes and lung cancer than from respiratory failure. These mortality statistics are supported by evidence from large COPD studies in which the cause of death has been carefully established. In the lung health study, 25% of deaths were due to cardiovascular disease (CVD) (average age 50 years, FEV1% average expected 79), and in the study Towards a revolution in COPD health (TORCH ), the proportion was 27% (mean age 65, FEV1% mean expected 44). In mild to moderate COPD, three times more hospital admissions in this group of patients are for cardiovascular causes than pulmonary, therefore, CVD morbidity is also high in patients with COPD. The most obvious explanation for the high cardiovascular morbidity and mortality seen in COPD patients is the high prevalence among this group of smokers and other known risk factors for coronary artery disease, such as poor diet, a sedentary lifestyle and a low socioeconomic class. However, several large population-based studies have shown that predicted FEV1% is associated with cardiovascular risk, even after adjusting for known cardiovascular risk factors, including age, gender, smoking, cholesterol and level of education / social class. Surprisingly, the FEV1 predicted at 1% is associated with cardiovascular risk even in non-smokers. Another proof that the association between COPD and CVD is real, and not due to coding errors, comes from the study of measures of central arterial stiffness, a new technique for assessing cardiovascular risk. The heart generates a pressure wave that travels through the arterial tree. Healthy arteries conform causing a slow transit time for the wave, and in more rigid arteries, the pressure wave travels faster. Using non-invasive measurement techniques, the speed of the wave between two points can be measured. This measure (called the pulse wave speed) can be a better measure of cardiovascular risk than the blood pressure measured at the periphery because it more closely reflects the pathological state of the central arteries and seems to be better associated with the atheroma load. coronary arteries and known risk factors such as smoking. William MacNee

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