Incidence of comorbidities in hospitalized chronic obstructive pulmonary disease patients and correlated risk factors

目的 调查住院慢性阻塞性肺疾病(COPD)患者合并症分布情况及相关危险因素.方法 对北京大学第三医院2003年1月至2008年12月出院诊断包含有COPD的患者的临床资料进行回顾性分析,统计合并症分布情况(对反复住院的患者以最近一次住院资料为准),并对其危险因素进行Logistic多因素回归分析.结果 共495例患者出院诊断包含有COPD,363例(73.3％)合并其他疾患,前5位的合并症分别为:高血压297例(60.0％)、缺血性心脏病79例(16.0％)、恶性肿瘤54例(10.9％)、糖尿病52例(10.5％)、慢性充血性心力衰竭和血脂异常各49例(9.9％).第1秒用力呼气量占预计值百分比(FEV1％预计值)＜30％、≥30％～＜50％、≥50％～＜80％、≥80％四组患者合并缺血性心脏病的比例分别为9.2％、12.7％、21.3％、16.5％ (P=0.052),合并血脂异常的比例分别为5.3％、5.7％、10.9％、20.3％ (P=0.002).体质指数＜18.5、18.5～23.9、24.0～27.9、≥28.Okg/m2 4组患者合并缺血性心脏病的比例分别为13.6％、14.2％、14.6％、28.3％(P=0.051),合并血脂异常的比例分别为5.5％、5.7％、14.6％、25.O％(P=0.000).过去1年因COPD急性发作住院次数≥2次和＜2次患者合并缺血性心脏病的比例分别为4.8％和24.0％(P=0.000).血清C反应蛋白水平高于第75百分位数(OR=2.371,P=0.014)、合并代谢综合征(OR=2.694,P=0.003)是COPD患者合并缺血性心脏病的危险因素.结论 不同COPD人群,合并症分布情况不同；血CRP水平高、合并代谢综合征是COPD患者合并缺血性心脏病的独立危险因素.Objective To explore the incidence of comorbidities in hospitalized chronic obstructive pulmonary disease (COPD) patients and influencing factors.Methods A rctrospective review of medical records was performed for 495 hospitalized COPD patients in Peking University Third Hospital from Januray 2003 to December 2008.Their commorbidities were identified and ranked in prevalence.The risk factors of commorbidities were analyzed by multivariable Logistic regression.Results The most frequent comorbidities were:hypertension (60.0％),ischemic heart disease (16.0％),malignant tumor (10.9％),diabetes mellitus (10.5％),chronic heart failure (9.9％) and dyslipidemia (9.9％).The percentage of patients with ischemic heart disease in people with FEV1％ Pred＜30％,30％≤FEV1％ Pred＜50％,50％≤FEV1％ Pred＜80％ and FEV1％ Pred≥80％ were 9.2％,12.7％,21.3％ and 16.5％ respectively (P=0.052 ). The percentage of patients with dyslipidemia in people with FEV1％ Pred＜30％,30％≤FEV1％ Pred＜50％,50％≤FEV1％ Pred＜80％,FEV1％ Pred ≥80％ were 5.3％,5.7％,10.9％ and 20.3％ respectively (P=0.002).The percentage of patients with ischemic heart disease in people with body mass index (BMI) ＜18.5,18.5-23.9,24.0-27.9,≥28.0 kg/m2 were 13.6％,14.2％,14.6％ and 28.3％ respectively (P=0.051).The percentage of patients with dyslipidemia in people with BMI＜18.5,18.5-23.9,24.0-27.9,≥28.0 kg/m2 were 5.5％,5.7％,14.6％ and 25.0％ respectively (P=0.000).The levels of C-reactive protein (CRP) were higher than the 75th percentile (OR=2.371,P=0.014),and complications with metabolic syndrome (OR=2.694,P=0.003) were independent risk factors of ischemic heart disease in COPD patients.Conclusions The incidence of comorbidities varies in different COPD populations.Higher levels of CRP and complications with metabolic syndrome are independent risk factors of ischemic heart disease in COPD patients.中华医学会临床医学科研专项基金PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)014943-9479