β-受体阻滞剂在慢性阻塞性肺疾病患者的应用价值探讨
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摘要
目的探讨β-受体阻滞剂在慢性阻塞性肺疾病(简称慢阻肺)患者中的安全有效性及其对预后的影响。方法回顾性分析366例我科收治的慢阻肺急性加重期患者的病历资料,评估β-受体阻滞剂的使用率和相关事件,对合并症、适应证、禁忌证及相关临床指标进行分析。结果 366例患者中,156例(42.6%)至少有1种使用β-受体阻滞剂的适应证,这些患者中使用β-受体阻滞剂的仅53例(34.0%),无禁忌但未使用β-受体阻滞剂的有61例(39.1%)。入院时使用β-受体阻滞剂的患者有72例(19.7%),使用抗血小板药物177例(45.6%),使用他汀类药物145例(39.6%),使用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂168例(45.9%)。25例(6.8%)在住院期间发生了缺血性心脏病事件,57例(15.6%)在入院期间发生心脑血管事件。发生心脑血管事件的患者住院时间更长(P<0.01),住院死亡率更高(P=0.02)。结论慢阻肺患者有明确的β-受体阻滞剂使用适应证,但临床上使用率仍然很低。需要进一步的研究来探讨对慢阻肺患者β-受体阻滞剂的应用。
Objectives To explore the safety and efficacy of beta-blockers(BBs) in patients with chronic obstructive pulmonary disease(COPD) and its effect on prognosis.Methods The data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively.The use rate and related events of BBs were evaluated,including comorbidity,indications,contraindications and related clinical indicators.Results Of the 366 patients,156(42.6%) had at least one indication of the use of BBs,but only 53(34.0%) of these patients used BBs,and 61 patients(39.1%) had no contraindications but did not use BBs.At admission,72 patients(19.7%) were treated with BBs,177(45.6%) with antiplatelet drugs,145(39.6%) with statins,and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168(45.9%) patients.Twenty-five patients(6.8%) had ischemic heart disease during hospitalization.Fifty-seven patients(15.6%) had cardiovascular and cerebrovascular events during admission.The patients with cardiovascular and cerebrovascular events had longer hospitalization(P<0.01) and higher in-hospital mortality(P=0.02).Conclusions Patients with COPD have a clear indication of BBs use,but the clinical use rate is still very low.Further research is needed to explore the prescription disorders of BBs in patients with COPD.
Objectives To explore the safety and efficacy of beta-blockers(BBs) in patients with chronic obstructive pulmonary disease(COPD) and its effect on prognosis.Methods The data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively.The use rate and related events of BBs were evaluated,including comorbidity,indications,contraindications and related clinical indicators.Results Of the 366 patients,156(42.6%) had at least one indication of the use of BBs,but only 53(34.0%) of these patients used BBs,and 61 patients(39.1%) had no contraindications but did not use BBs.At admission,72 patients(19.7%) were treated with BBs,177(45.6%) with antiplatelet drugs,145(39.6%) with statins,and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168(45.9%) patients.Twenty-five patients(6.8%) had ischemic heart disease during hospitalization.Fifty-seven patients(15.6%) had cardiovascular and cerebrovascular events during admission.The patients with cardiovascular and cerebrovascular events had longer hospitalization(P<0.01) and higher in-hospital mortality(P=0.02).Conclusions Patients with COPD have a clear indication of BBs use,but the clinical use rate is still very low.Further research is needed to explore the prescription disorders of BBs in patients with COPD.
引文
1World Health Organization Factsheet. Chronic obstructive pulmonary disease(COPD); Fact sheet; November 2016. Available at:http://www.who.int/mediacentre/factsheets/fs315/en/. Accessed March 23, 2017.
2Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest, 2003, 124(2):459-467.
3Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest, 2002, 121(5):1441-1448.
4Soler-Catalu?a JJ, Martínez-García Má, Román Sánchez P, et al.Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 2005, 60(11):925-931.
5Global Initiative for Chronic Obstructive Lung Disease(GOLD).Global strategy for diagnosis, management, and prevention of COPD; 2016. Available from:http://goldcopd.org/global-strategydiagnosismanagement-prevention-copd-2016/. Accessed January18, 2016.
6杜飞,张李,陈代刚,等.不同程度的慢性阻塞性肺疾病患者合并心血管疾病及其危险因素的比较.中国呼吸与危重监护杂志,2017, 16(4):311-313.
7Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J COPD, 2014, 8(9):871-888.
8Miller J, Edwards LD, AgustíA, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med,2013, 107(9):1376-1384.
9Divo M, Cote C, de Torres JP, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2012, 186(2):155-161.
10Quint JK, Herrett E, Bhaskaran K, et al. Effect ofβblockers on mortality after myocardial infarction in adults with COPD:population based cohort study of UK electronic healthcare records.BMJ, 2013, 347:f6650.
11 Short PM, Lipworth SW, Elder DHJ, et al. Effect ofβblockers in treatment of chronic obstructive pulmonary disease:a retrospective cohort study. BMJ, 2011, 342:d2549.
12Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD:a meta-analysis.Chest, 2004, 125(6):2309-2321.
13中华医学会呼吸病分会慢性阻塞性肺部疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版).中华结核和呼吸杂志, 2013,36(4):255-264.
14McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure2012:The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association(HFA)of the ESC. Eur J Heart Fail, 2012, 14(8):803-869.
15Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary. Am J Respir Crit Care Med, 2013, 187(4):347-365.
16Harrison MT, Short P, Williamson PA, et al. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease:a role for antiplatelet therapy. Thorax, 2014, 69(7):609-615.
17Lipworth B, Skinner D, Devereux G, et al. Underuse ofβ-blockers in heart failure and chronic obstructive pulmonary disease. Heart,2016, 102(23):1909-1914.
18Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD.Chest, 2010, 137(5):1091-1097.
19MacGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD:operations of the TORCH Clinical Endpoint Committee. Thorax, 2007, 62(5):411-415.
20MacDonald MI, Shafuddin E, King PT, et al. Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease.Lancet Respir Med, 2016, 4(2):138-148.
21Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease:cardiovascular links. Biomed Res Int, 2014,2014:528789.
22Du Q, Sun Y, Ding N, et al. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD:a meta-analysis of observational studies. PLoS One, 2014, 9(11):e113048.
23Bhatt SP, Connett JE, Voelker H, et al.β-blockers for the prevention of acute exacerbations of chronic obstructive pulmonary disease(βLOCK COPD):a randomized controlled study protocol. BMJ Open, 2016, 6(6):e012292.
24Su VY, Chang YS, Hu YW, et al. Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease. Medicine(Baltimore), 2016, 95(5):e2427.
25 Jabbour A, Macdonald PS, Keogh M, et al. Differences between betablockers in patients with chronic heart failure and chronic obstructive pulmonary disease:a randomized crossover trial. J Am Coll Cardiol, 2016, 55(17):1780-1787.
2Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality related factors after hospitalization for acute exacerbation of COPD. Chest, 2003, 124(2):459-467.
3Almagro P, Calbo E, Ochoa de Echagüen A, et al. Mortality after hospitalization for COPD. Chest, 2002, 121(5):1441-1448.
4Soler-Catalu?a JJ, Martínez-García Má, Román Sánchez P, et al.Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 2005, 60(11):925-931.
5Global Initiative for Chronic Obstructive Lung Disease(GOLD).Global strategy for diagnosis, management, and prevention of COPD; 2016. Available from:http://goldcopd.org/global-strategydiagnosismanagement-prevention-copd-2016/. Accessed January18, 2016.
6杜飞,张李,陈代刚,等.不同程度的慢性阻塞性肺疾病患者合并心血管疾病及其危险因素的比较.中国呼吸与危重监护杂志,2017, 16(4):311-313.
7Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J COPD, 2014, 8(9):871-888.
8Miller J, Edwards LD, AgustíA, et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respir Med,2013, 107(9):1376-1384.
9Divo M, Cote C, de Torres JP, et al. Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 2012, 186(2):155-161.
10Quint JK, Herrett E, Bhaskaran K, et al. Effect ofβblockers on mortality after myocardial infarction in adults with COPD:population based cohort study of UK electronic healthcare records.BMJ, 2013, 347:f6650.
11 Short PM, Lipworth SW, Elder DHJ, et al. Effect ofβblockers in treatment of chronic obstructive pulmonary disease:a retrospective cohort study. BMJ, 2011, 342:d2549.
12Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD:a meta-analysis.Chest, 2004, 125(6):2309-2321.
13中华医学会呼吸病分会慢性阻塞性肺部疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版).中华结核和呼吸杂志, 2013,36(4):255-264.
14McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure2012:The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association(HFA)of the ESC. Eur J Heart Fail, 2012, 14(8):803-869.
15Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:GOLD executive summary. Am J Respir Crit Care Med, 2013, 187(4):347-365.
16Harrison MT, Short P, Williamson PA, et al. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease:a role for antiplatelet therapy. Thorax, 2014, 69(7):609-615.
17Lipworth B, Skinner D, Devereux G, et al. Underuse ofβ-blockers in heart failure and chronic obstructive pulmonary disease. Heart,2016, 102(23):1909-1914.
18Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD.Chest, 2010, 137(5):1091-1097.
19MacGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD:operations of the TORCH Clinical Endpoint Committee. Thorax, 2007, 62(5):411-415.
20MacDonald MI, Shafuddin E, King PT, et al. Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease.Lancet Respir Med, 2016, 4(2):138-148.
21Laratta CR, van Eeden S. Acute exacerbation of chronic obstructive pulmonary disease:cardiovascular links. Biomed Res Int, 2014,2014:528789.
22Du Q, Sun Y, Ding N, et al. Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD:a meta-analysis of observational studies. PLoS One, 2014, 9(11):e113048.
23Bhatt SP, Connett JE, Voelker H, et al.β-blockers for the prevention of acute exacerbations of chronic obstructive pulmonary disease(βLOCK COPD):a randomized controlled study protocol. BMJ Open, 2016, 6(6):e012292.
24Su VY, Chang YS, Hu YW, et al. Carvedilol, bisoprolol, and metoprolol use in patients with coexistent heart failure and chronic obstructive pulmonary disease. Medicine(Baltimore), 2016, 95(5):e2427.
25 Jabbour A, Macdonald PS, Keogh M, et al. Differences between betablockers in patients with chronic heart failure and chronic obstructive pulmonary disease:a randomized crossover trial. J Am Coll Cardiol, 2016, 55(17):1780-1787.