Chronic Obstructive Pulmonary Disease is Associated with an Increased Risk of Peripheral Arterial Disease

慢性阻塞性肺病伴隨著增加周邊動脈疾病的風險

沈德群(Te-Chun Shen) ； 陳煒(Wei Chen) ； 林橙莉(Cheng-Li Lin) ； 黃國揚(Kuo-Yang Huang) ； 陳家弘(Chia-Hung Chen) ； 涂智彥(Chih-Yen Tu) ； 夏德椿(Te-Chun Hsia) ； 施純明(Chuen-Ming Shih) ； 徐武輝(Wu-Huei Hsu) ； 張晏蓉(Yen-Jung Chang)

《內科學誌》 25卷4期 (2014/08) Pp. 272-280

https://doi.org/10.6314/JIMT.2014.25(4).06

摘要

慢性阻塞性肺病、周邊動脈疾病與缺血性心臟病被並稱為抽菸的三合症，然而只有少數小型的研究探討過慢性阻塞性肺病與周邊動脈疾病之間的關係，我們嘗試使用台灣健保資料庫來檢驗慢性阻塞性肺病的病人之後罹患周邊動脈疾病的風險。我們利用台灣的健保資料庫來設計一個回溯性的世代研究，慢性阻塞性肺病群組包含了361,023位自1998至2008被新診斷為慢性阻塞性肺病的病人，每一位病人根據年齡、性別與疾病診斷時間隨機分配兩位對照個案作為對照群組，我們持續追蹤兩組是否有新診斷的周邊動脈疾病至2010年底，並評估發生周邊動脈疾病的相對風險。慢性阻塞性肺病群組比對照組發生周邊動脈疾病的比例整體高出2.34倍（每千人年為3.71比1.58），深入分析發現發生周邊動脈疾病的風險在男性較女性、年紀低於50歲較年紀大於50歲與沒有併發症較有併發症者相對要來得高。此一研究顯示患有慢性阻塞性肺病的病人比對照組有較高的風險罹患周邊動脈疾病，而且年紀愈輕的患者相對風險更高，因此，在患有慢性阻塞性肺病的病人當中篩檢是否罹患周邊動脈疾病，也許是個可以推行的方案。

並列摘要

Chronic obstructive pulmonary disease (COPD), peripheral arterial disease (PAD) and ischemic heart disease are considered to be a smoking-related triad. However, only a few studies investigated the relationship between COPD and PAD using limited study sample. We aimed to examine the risk of PAD among patients with COPD using a nationwide cohort database in Taiwan. We conducted a retrospective cohort study using data from the National Health Insurance system of Taiwan. The COPD cohort included 361,023 patients who were newly diagnosed and recruited between 1998 and 2008. Each patient with COPD was randomly frequency-matched with two participants without COPD on age, sex, and the year of index date. The newly diagnosis of PAD was followed up until the end of 2010. The relative risks of PAD were estimated using Cox proportional hazard models after adjusting for age, sex, index year and comorbidities. The overall incidence rate of PAD was 2.34–fold greater in the COPD cohort than in the non-COPD cohort (3.71 vs. 1.58 per 1000 person-years). Further analyses indicated that the risk of PAD was higher in males, individuals younger than 50 years, and without comorbidity among the subgroups. This nationwide population-based study indicates that the incidence of PAD is significantly higher in patients with COPD than in those without COPD and the hazard ratio was especially high in younger patients. Therefore, regular examination for PAD in patients with COPD may be considered.

並列關鍵字

Peripheral arterial disease (PAD) ； Chronic obstructive pulmonary disease (COPD) ； Epidemiology