河北医科大学学报 ›› 2022, Vol. 43 ›› Issue (4): 386-390.doi: 10.3969/j.issn.1007-3205.2022.04.004

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吸烟与贫血交互作用影响慢性阻塞性肺疾病易感性的临床研究

  

  1. 首都医科大学附属北京康复医院呼吸与危重症医学科，北京 100041
  • 出版日期:2022-04-25 发布日期:2022-04-30
  • 作者简介:刘梅霞（1988-），女，河北石家庄人，首都医科大学附属北京康复医院主治医师，医学学士，从事呼吸疾病诊治研究。
  • 基金资助:

    北京市卫生科技发展专项基金（2018-2-117）

A clinical study on the interaction between smoking and anemia factors affecting the susceptibility to chronic obstructive pulmonary disease

  1. Department of Respiratory and Critical Care Medicine, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100041, China
  • Online:2022-04-25 Published:2022-04-30

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摘要：

目的  探讨吸烟、贫血与慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）易感性的关系及其交互作用，为筛选COPD高危人群及防治COPD提供依据。

方法  选我院收治的89例COPD患者（COPD组）及89例健康人群（对照组），比较2组年龄、体重指数（body mass index，BMI）、合并疾病、文化层次、婚姻状况、吸烟情况、吸烟指数（smoking index ，SI）、贫血情况、血红蛋白（hemoglobin，Hb）水平、一秒钟用力呼气容积（forced expiratory volume in one second，FEV1）占用力肺活量（forced vital capacity，FVC）百分比（FEV1/FVC）、一秒钟用力呼气容积占预计值百分比（FEV1% pred），采用Pearson分析SI、Hb与FEV1/FVC、FEV1% pred相关性，采用Logistic回归方程分析COPD的相关影响因素，使用相对超危险度比（relative excess risk ratio，RERI）、归因比（attribution ratio ，AP）、交互作用指数（interaction index ，S）分析吸烟、贫血对COPD易感性的交互作用。

结果  Pearson相关性分析，SI与FEV1/FVC、FEV1% pred呈负相关（P＜0.05）；Hb与FEV1/FVC、FEV1% pred呈正相关（P＜0.05）。吸烟、贫血、FEV1/FVC、FEV1% pred与COPD的易感性相关（P＜0.05）。吸烟因素分层后，吸烟者组间贫血情况分布，差异有统计学意义（P＜0.05）。吸烟、贫血与COPD易感性相关，OR值分别为3.384、1.141；吸烟与贫血存在正向相加模型的交互作用，两种因素共存时，COPD发病风险是非吸烟、非贫血者的6.600倍。交互作用分析显示，S=2.218，RERI=3.075，AP=46.59%，由吸烟、贫血交互作用造成的COPD患病率是其他未预测因子造成患病率的3.075倍，在吸烟、贫血共存的COPD患病危险性中，有46.59%是由两者交互作用引起的。

结论  吸烟、贫血与COPD病情密切相关；吸烟、贫血、肺功能是COPD易感性的影响因素；吸烟、贫血在COPD易感性中具有交互作用。

关键词: 肺疾病, 慢性阻塞性；吸烟；贫血

Abstract:

Objective  To explore the relationship and interaction between smoking, anemia and susceptibility to chronic obstructive pulmonary disease(COPD), and to provide evidence for screening high-risk population and prevention and treatment of COPD.

Methods  Eighty-nine patients with COPD(COPD group) and 89 healthy people(control group) were selected. Age, body mass index(BMI), comorbid diseases, educational level, marital status, smoking status, smoking index(SI), anemia status, hemoglobin(Hb) level, forced expiratory volume in one second as a percentage of forced vital capacity(FEV1/FVC), and forced expiratory volume in one second as percentage of predicted value(FEV1% pred) were compared between two groups. Pearson correlation analysis was used to analyze the correlation between SI, Hb and FEV1/FVC, FEV1% pred, and the Logistic regression equation was used to analyze the related influencing factors of COPD. The relative excess risk ratio(RERI), attribution ratio(AP) and interaction index(S) were used to analyze the interaction between smoking, anemia and the susceptibility to COPD.

Results  Pearson correlation analysis showed that SI was negatively correlated with FEV1/FVC and FEV1% pred(P＜0.05), while Hb was positively correlated with FEV1/FVC and FEV1% pred(P＜0.05). Smoking, anemia, FEV1/FVC, and FEV1% pred were related to the susceptibility to COPD(P＜0.05).  After smoking factor stratification, the distribution of anemia among the smokers′ groups was significantly different (P＜0.05). Smoking and anemia were related to the susceptibility to COPD, with OR values of 3.384 and 1.141, respectively. There was a positive additive interaction between smoking and anemia. When the two factors coexisted, the risk of COPD was 6.600 times that of non-smokers and non-anemia patients. The interaction analysis showed S=2.218, RERI=3.075, and AP=46.59%. The prevalence of COPD caused by the interaction of smoking and anemia was 3.075 times higher than that caused by other unpredictable factors. In addition, 46.59% of the risk of COPD in patients with coexistence of smoking and anemia was caused by the interaction of the two.

Conclusion  Smoking, anemia and COPD are closely related. Smoking, anemia, and lung function are the influencing factors of susceptibility to COPD. Smoking and anemia have an interactive effect on susceptibility to COPD.

Key words: pulmonary disease, chronic obstructive, smoking, anemia

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