慢性阻塞性肺疾病合并高血压的临床特征及危险因素分析

doi:10.3877/cma.j.issn.1674-6902.2020.06.006

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (06) : 746 -750. doi: 10.3877/cma.j.issn.1674-6902.2020.06.006

论著

慢性阻塞性肺疾病合并高血压的临床特征及危险因素分析

王美菊¹, 胡明冬², 陈华萍², 徐静¹^,^†(

), 刘双林¹, 刘刚¹, 张文静¹, 刘熙¹, 焦玉丁¹, 刘士琛¹, 王勤³, 李琦¹^,^†(

)

^1. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学中心
^2. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸与危重症医学中心；400037　重庆，陆军（第三）军医大学第二附属医院老年与特勤医学科
^3. 400016　重庆，重庆医科大学第二附属医院呼吸与危重症医学科

收稿日期:2020-08-17 出版日期:2020-12-25
通信作者: 徐静, 李琦
基金资助:
国家自然科学基金资助项目(81800084); 陆军军事医学创新工程专项(18CXZ002)

Clinical characteristics and risk factors of chronic obstructive pulmonary disease complicated with hypertension

Meiju Wang¹, Mingdong Hu², Huaping Chen², Jing Xu¹^,^†(), Shuanglin Liu¹, Gang Liu¹, Wenjing Zhang¹, Xi Liu¹, Yuding Jiao¹, Shichen Liu¹, Qin Wang³, Qi Li¹^,^†()

^1. Department of Respiratory and Critical Care Medicine Center, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
^2. Department of Respiratory and Critical Care Medicine Center, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China; Department of Gerontology and Secret Service Medicine, the Second Affiliated Hospital of Army Medical University, Chongqing 400037, China
^3. Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Received:2020-08-17 Published:2020-12-25
Corresponding author: Jing Xu, Qi Li

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引用本文：

王美菊, 胡明冬, 陈华萍, 徐静, 刘双林, 刘刚, 张文静, 刘熙, 焦玉丁, 刘士琛, 王勤, 李琦. 慢性阻塞性肺疾病合并高血压的临床特征及危险因素分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(06): 746-750.

Meiju Wang, Mingdong Hu, Huaping Chen, Jing Xu, Shuanglin Liu, Gang Liu, Wenjing Zhang, Xi Liu, Yuding Jiao, Shichen Liu, Qin Wang, Qi Li. Clinical characteristics and risk factors of chronic obstructive pulmonary disease complicated with hypertension[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(06): 746-750.

目的

观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并高血压的临床特征，同时分析其相关的危险因素。

方法

收集陆军军医大学新桥医院2016年1月至2018年12月住院的COPD合并高血压患者122例，观察COPD合并高血压的临床特征，同时以单纯COPD患者40例为对照组，应用多因素Logistic回归分析COPD合并高血压的危险因素。

结果

122例COPD合并高血压患者中，29.41%合并冠心病、22.99%合并肾疾病和糖尿病、21.39%合并肺心病、14.97%合并脑梗死、4.28%合并心绞痛、4.28%合并心肌梗死、9.63%合并其他心血管疾病。合并冠心病、心肌梗死、其他心血管疾病患者平均年龄显著高于COPD合并高血压患者对照组(P<0.05)；合并肺心病患者病程显著长于对照组(P<0.05)；合并冠心病、糖尿病、脑梗死、心绞痛、心肌梗死患者每年急性加重次数显著多余对照组(P<0.05)；合并心绞痛和其他心血管疾病患者住院时间显著长于对照组(P<0.05)。多因素Logistic回归分析显示年龄(>80岁)、吸烟支数(>700支/年)、饮酒史、CRP(>50 mg/L)、BNP(>100 ng/L)、高血糖是COPD患者合并高血压的危险因素。

结论

COPD合并高血压易引起其他相关性疾病而加重病情，及早关注其危险因素可提高患者预后。

关键词: 肺疾病, 慢性阻塞性, 高血压, 合并症, 危险因素

Objective

To explore the clinical characteristics of chronic obstructive pulmonary disease (COPD) with hypertension, and analyze the risk factors.

Methods

One hundred twenty-two patients with COPD and hypertension were collected from department of respiratory and critical care medicine center of Xinqiao Hospital from January 2016 to December 2018, and observed their clinical characteristics. Meanwhile, 40 COPD patients as control group, the risk factors were analyzed by multi factor Logistic regression.

Results

Among 122 COPD patients with hypertension, 29.41% were complicated with coronary heart disease, 22.99% with renal disease and diabetes, 21.39% with pulmonary heart disease, 14.97% with cerebral infarction, 4.28% with angina pectoris, 4.28% with myocardial infarction and 9.63% with other cardiovascular diseases. The age of patients with coronary heart disease, myocardial infarction and other cardiovascular diseases was significantly higher than that of COPD patients with hypertension (P<0.05); the disease course of with cor pulmonale was remarkably longer than that of control group (P<0.05); the number of acute exacerbations with coronary heart disease, diabetes, cerebral infarction, angina pectoris and myocardial infarction was obviously more than that in the control group (P<0.05); the hospitalization time of patients with angina pectoris and other cardiovascular diseases was significantly longer compared with control group (P<0.05). Logistic regression analysis showed that over 80 years old, smoking more than 700 per year, drinking, C-reactive protein (CRP) more than 50 mg/L, B-type brain natriuretic peptide(BNP) more than 100 ng/L, hyperglycemia were the risk factors of COPD with hypertension.

Conclusion

COPD complicated with hypertension often caused other related diseases and aggravated the disease. Therefore, it is necessary to pay attention to risk factors as early as possible, which will improve the prognosis of patients.

Key words: Chronic obstructive pulmonary disease, Hypertension, Complications, Risk factors

表1 COPD合并高血压患者的合并疾病情况

疾病谱	病例数[n(%)]	年龄(年)	病程(年)	急性加重次数(次/年)	住院时间(d)
COPD合并高血压	122	70.72±9.63	13.30±12.45	2.65±2.83	11.20±6.34
冠心病	55(29.41)	76.47±8.63^a	14.51±7.43	4.13±3.53^a	11.87±7.43
肾疾病	43(22.99)	72.49±9.30	13.14±10.97	2.23±2.06	12.51±7.10
糖尿病	43(22.99)	70.58±9.70	14.56±12.38	3.20±3.04^a	11.39±5.97
肺心病	40(21.39)	73.98±6.64	20.90±15.80^a	1.98±1.51	11.53±6.46
脑梗死	28(14.97)	74.64 ±8.92	12.69±12.03	4.07±4.26^a	12.57±8.85
心绞痛	8(4.28)	73.38±9.02	17.50±11.39	3.88±2.85^a	17.87±11.39^a
心肌梗死	8(4.28)	77.12±4.09^a	9.28±7.91	3.50±3.50^a	10.63±5.73
其他心血管疾病	18(9.63)	76.00±8.1^a	13.33±12.09	2.06±1.39	15.0±10.24^a

表1 COPD合并高血压患者的合并疾病情况

疾病谱	病例数[n(%)]	年龄(年)	病程(年)	急性加重次数(次/年)	住院时间(d)
COPD合并高血压	122	70.72±9.63	13.30±12.45	2.65±2.83	11.20±6.34
冠心病	55(29.41)	76.47±8.63^a	14.51±7.43	4.13±3.53^a	11.87±7.43
肾疾病	43(22.99)	72.49±9.30	13.14±10.97	2.23±2.06	12.51±7.10
糖尿病	43(22.99)	70.58±9.70	14.56±12.38	3.20±3.04^a	11.39±5.97
肺心病	40(21.39)	73.98±6.64	20.90±15.80^a	1.98±1.51	11.53±6.46
脑梗死	28(14.97)	74.64 ±8.92	12.69±12.03	4.07±4.26^a	12.57±8.85
心绞痛	8(4.28)	73.38±9.02	17.50±11.39	3.88±2.85^a	17.87±11.39^a
心肌梗死	8(4.28)	77.12±4.09^a	9.28±7.91	3.50±3.50^a	10.63±5.73
其他心血管疾病	18(9.63)	76.00±8.1^a	13.33±12.09	2.06±1.39	15.0±10.24^a

表2 COPD合并高血压的临床特征

临床资料		COPD组	COPD合并高血压组	χ²/Z/t值	P值
病例数(n)		40	122
	<60岁	8(20.25)	17(8.19)	0.978	0.323
	60～70岁	16(40.50)	43(35.24)	0.297	0.585
	70～80岁	14(35.44)	43(35.24)	0.003	0.953
	>80岁	2(5.06)	19(15.57)	4.355	0.041
性别(男/女，n)		27/13	78 /44	0.168	0.682
年龄(岁)		66.30±9.08	70.72±9.63	-2.421	0.015
COPD病程(年)		7.87±8.56	13.42±9.45	-1.852	0.064
急性加重次数(次/年)		1.52±0.68	2.55±1.18	-2.512	0.013
吸烟时间(年)		25.58±14.89	34.55±13.01	-3.708	0.001
吸烟支数(支/年)		652.38±300.96	923.67±347.90	-3.964	0.000
饮酒史[n(%)]		12(30.00)	62(50.81)	15.373	0.000
FEV₁/预计值(%)		50.92±15.97	47.05±15.19	2.370	0.019
GOLD分级[n(%)]
	1级(>80)	5(12.50)	4(4.09)	4.189	0.055
	2级(50～80)	22(55.00)	42(34.42)	2.161	0.185
	3/4级(<50)	13(32.50)	76(62.29)	3.507	0.705
CRP(mg/L)		45.31±40.69	64.84±62.28	2.037	0.044
BNP(mg/L)		140.28±230.97	485.46±990.01	-2.430	0.017
血糖(mmol/L)		6.52±1.67	8.93±3.69	-4.270	0.000

表2 COPD合并高血压的临床特征

临床资料		COPD组	COPD合并高血压组	χ²/Z/t值	P值
病例数(n)		40	122
	<60岁	8(20.25)	17(8.19)	0.978	0.323
	60～70岁	16(40.50)	43(35.24)	0.297	0.585
	70～80岁	14(35.44)	43(35.24)	0.003	0.953
	>80岁	2(5.06)	19(15.57)	4.355	0.041
性别(男/女，n)		27/13	78 /44	0.168	0.682
年龄(岁)		66.30±9.08	70.72±9.63	-2.421	0.015
COPD病程(年)		7.87±8.56	13.42±9.45	-1.852	0.064
急性加重次数(次/年)		1.52±0.68	2.55±1.18	-2.512	0.013
吸烟时间(年)		25.58±14.89	34.55±13.01	-3.708	0.001
吸烟支数(支/年)		652.38±300.96	923.67±347.90	-3.964	0.000
饮酒史[n(%)]		12(30.00)	62(50.81)	15.373	0.000
FEV₁/预计值(%)		50.92±15.97	47.05±15.19	2.370	0.019
GOLD分级[n(%)]
	1级(>80)	5(12.50)	4(4.09)	4.189	0.055
	2级(50～80)	22(55.00)	42(34.42)	2.161	0.185
	3/4级(<50)	13(32.50)	76(62.29)	3.507	0.705
CRP(mg/L)		45.31±40.69	64.84±62.28	2.037	0.044
BNP(mg/L)		140.28±230.97	485.46±990.01	-2.430	0.017
血糖(mmol/L)		6.52±1.67	8.93±3.69	-4.270	0.000

表3 COPD合并高血压危险因素的多因素Logistic回归分析

因　素	B	SE	Wald值	P值	OR值	95%CI
年龄(>80岁)	1.062	0.501	4.487	0.034	2.892	1.087～7.728
吸烟时间(>20年)	0.064	0.504	0.016	0.900	0.938	0.350～2.518
吸烟支数(>700支/年)	1.792	0.513	12.173	0.000	5.999	2.193～16.411
饮酒史	1.336	0.505	7.006	0.008	3.803	1.414～10.224
CRP(>50 mg/L)	0.710	0.485	2.149	0.143	2.034	0.787～5.258
BNP(>100 ng/L)	1.917	0.496	14.936	0.000	6.802	2.573～17.986
高血糖	1.480	0.490	9.131	0.003	4.392	1.682～11.470

表3 COPD合并高血压危险因素的多因素Logistic回归分析

因　素	B	SE	Wald值	P值	OR值	95%CI
年龄(>80岁)	1.062	0.501	4.487	0.034	2.892	1.087～7.728
吸烟时间(>20年)	0.064	0.504	0.016	0.900	0.938	0.350～2.518
吸烟支数(>700支/年)	1.792	0.513	12.173	0.000	5.999	2.193～16.411
饮酒史	1.336	0.505	7.006	0.008	3.803	1.414～10.224
CRP(>50 mg/L)	0.710	0.485	2.149	0.143	2.034	0.787～5.258
BNP(>100 ng/L)	1.917	0.496	14.936	0.000	6.802	2.573～17.986
高血糖	1.480	0.490	9.131	0.003	4.392	1.682～11.470

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Clinical characteristics and risk factors of chronic obstructive pulmonary disease complicated with hypertension

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Clinical characteristics and risk factors of chronic obstructive pulmonary disease complicated with hypertension