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Am J Respir Crit Care Med:慢阻肺患者更易出现颈动脉壁易碎斑块

2013-01-09 Am J Respir Crit Care Med dxy sd3212

  慢性阻塞性肺疾病(COPD)是缺血性中风发病的一个独立危险因素,而且这种发病风险随着患者气流限制程度的增加而增加。虽然易损颈动脉斑块的组分(如斑块内出血和脂质核心),会使患者处于缺血性事件的高风险之中,但还从没有人对COPD患者动脉斑块的组成成分进行过研究。为了探讨在老年COPD患者中颈动脉壁增厚的发病情况、颈动脉斑块成分有何不同、以及它们与患者气流限制程度的关系,比利时根特根特大学医院、根特

  慢性阻塞性肺疾病(COPD)是缺血性中风发病的一个独立危险因素,而且这种发病风险随着患者气流限制程度的增加而增加。虽然易损颈动脉斑块的组分(如斑块内出血和脂质核心),会使患者处于缺血性事件的高风险之中,但还从没有人对COPD患者动脉斑块的组成成分进行过研究。为了探讨在老年COPD患者中颈动脉壁增厚的发病情况、颈动脉斑块成分有何不同、以及它们与患者气流限制程度的关系,比利时根特根特大学医院、根特大学呼吸医学教研室、流行病学教研室的Brusselle及其同事开展了一项研究,研究结果发表于2013年1月1日出版的《美国呼吸与危重症医学》( Am. J. Respir. Crit. Care Med)杂志上。研究结果显示:与对照组相比,COPD患者出现颈动脉壁增厚者更为普遍。在颈动脉壁增厚的中老年人中,COPD是其存在一个脂质核心动脉斑块--也就是存在易损斑块的一个独立预测指标。

  该研究是一项横断面分析研究,属于鹿特丹研究的一部分,而鹿特丹研究是在年龄为55岁及55岁以上的个体中进行的一项前瞻性、以人口为基础的队列研究。在该横断面分析研究中,其研究对象的COPD的诊断均经过了肺活量检查的证实。对于那些在超声检查时,显示颈动脉壁内膜-中层厚度大于或等于2.5毫米的研究对象,研究者使用高分辨率磁共振成像对其颈动脉斑块的特征进行了评估,并使用逻辑回归法对相关数据进行了分析。

  该研究的主要结果为:与肺功能正常的对照组(920例)相比,COPD患者(253例)在进行超声检查时,其出现颈动脉壁增厚表现的风险增加了2倍(胜算比,2.0;95%置信区间,1.44~2.85;p<0.0001)。而且,这种风险随着患者气流限制的加重而显著增加。磁共振成像显示,与对照组相比,COPD患者出现易碎的脂质核心斑块的几率更高(胜算比,2.1;95%置信区间,1.25~3.69;p=0.0058)。

  该研究结果显示:与对照组相比,COPD患者出现颈动脉壁增厚者更为普遍。在颈动脉壁增厚的中老年人中,COPD是患者存在一个脂质核心的动脉斑块--也就是存在易损斑块的一个独立预测指标。


Chronic obstructive pulmonary disease and lipid core carotid artery plaques in the elderly: the rotterdam study

Rationale: Chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic stroke and the risk increases with severity of airflow limitation. Even though vulnerable carotid artery plaque components, such as intraplaque hemorrhage and lipid core, place persons at high risk for ischemic events, the plaque composition in patients with COPD has never been explored.

Objectives: To investigate the prevalence of carotid wall thickening, the different carotid artery plaque components, and their relationship with severity of airflow limitation in elderly patients with COPD.

Methods: This cross-sectional analysis was part of the Rotterdam Study, a prospective population-based cohort study performed in subjects aged 55 years and older. Diagnosis of COPD was confirmed by spirometry. Participants with carotid wall intima-media thickness greater than or equal to 2.5 mm on ultrasonography underwent high-resolution magnetic resonance imaging for characterization of carotid plaques. Data were analyzed using logistic regression.

Measurements and Main Results: COPD cases (n = 253) had a twofold increased risk (odds ratio, 2.0; 95% confidence interval, 1.44–2.85; P < 0.0001) of presentation with carotid wall thickening on ultrasonography compared with control subjects with a normal lung function (n = 920). Moreover, the risk increased significantly with severity of airflow limitation. On magnetic resonance imaging, vulnerable lipid core plaques were more frequent in COPD cases than in control subjects (odds ratio, 2.1; 95% confidence interval, 1.25–3.69; P = 0.0058).


    

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