哮喘成人中的合并症：基于苏格兰140万成人群体的横断面研究
2017/07/12
摘要
背景：哮喘患者的合并症可以显著地增加哮喘的发病率，并降低哮喘患者的依从性。
目的：这个研究以大型的全国范围的代表性人群为样本，目的是全面估测成人哮喘患者中存在生理、心理合并症的患病率。
方法：通过对英国1424387名成人的常规基本电子医疗记录进行横断研究，在这些有或无哮喘的成人中分析39种合并症的患病率，并对年龄、性别、社会剥夺和吸烟史调整的前后进行分析。统计学方法使用logistic回归。
结果：在这39种合并疾病中，有36种（92%）疾病在哮喘病人中是更显著普遍存在的。62.6%的哮喘患者有≥1种疾病vs 46.2%的非哮喘人群（有≥1种疾病）;其中16.3%的哮喘人群有4种合并症VS 8.7%的非哮喘人群。在哮喘患者中更多的合并症包括:COPD(13.4% vs 3.1%)，抑郁(17.3% vs 9.1%)，痛苦(15.4% vs 8.4%)，消化不良(10.9% vs 5.2%)。在哮喘人群和非哮喘人群中最有区别的合并症如下:COPD（调整后的比值比 5.65,95%可信区间5.52-5.79）、支气管扩张症(aOR 4.65, 95%CI 4.26-5.08)、湿疹/银屑病(aOR 3.30, 95%CI 3.14-3.48)、消化不良(aOR 2.20, 95%CI 2.15-2.25)和慢性鼻窦炎(aOR 2.12, 95%CI 1.99-2.26)。抑郁和焦虑在哮喘人群中更普遍(前者aOR 1.60, 95%CI 1.57-1.63；后者 aOR 1.53, 95%CI 1.48-1.57)。
结论和临床相关性：在哮喘患者中，存在有身体和心理的合并症是常态。适当的识别以及处理应该成为日常哮喘治疗的一部分。
Comorbidities in adults with asthma: population-based crosssectional analysis of 1.4 million adults in Scotland
Weatherburn CJ, Guthrie B, Mercer SW, Morales DR
Abstract
Background: Comorbidity in people with asthma can significantly increase asthma morbidity and lower adherence to asthma guidelines.
Objective: The objective of this study was to comprehensively measure the prevalence of physical and mental health comorbidities in adults with asthma using a large nationally representative population.
Methods: Cross-sectional analysis of routine primary care electronic medical records for 1,424,378 adults in the UK, examining the prevalence of 39 comorbidities in people with and without asthma, before and after adjustment for age, sex, social deprivation and smoking status using logistic regression.
Results: Of 39 comorbidities measured, 36 (92%) were significantly more common in adults with asthma. 62.6% of adults with asthma had ≥1 comorbidity vs. 46.2% of those without, and 16.3% had ≥4 comorbidities vs. 8.7% of those without. Comorbidities with the largest absolute increase in prevalence in adults with asthma were: COPD (13.4% vs 3.1%), depression (17.3% vs 9.1%), painful conditions (15.4% vs 8.4%), and dyspepsia (10.9% vs 5.2%). Comorbidities with the largest relative difference in adults with asthma compared to without were: COPD (adjusted odds ratio [aOR] 5.65,95%CI 5.52-5.79), bronchiectasis (aOR 4.65, 95%CI 4.26-5.08), eczema/psoriasis (aOR 3.30, 95%CI 3.14-3.48), dyspepsia (aOR 2.20, 95%CI 2.15-2.25) and chronic sinusitis (aOR 2.12, 95%CI 1.99-2.26).Depression and anxiety were more common in adults with asthma (aOR 1.60, 95%CI 1.57-1.63, and aOR 1.53, 95%CI 1.48-1.57 respectively).
Conclusions and Clinical Relevance: Physical and mental health comorbidity is the norm in adults with asthma. Appropriate recognition and management should form part of routine asthma care.
背景：哮喘患者的合并症可以显著地增加哮喘的发病率，并降低哮喘患者的依从性。
目的：这个研究以大型的全国范围的代表性人群为样本，目的是全面估测成人哮喘患者中存在生理、心理合并症的患病率。
方法：通过对英国1424387名成人的常规基本电子医疗记录进行横断研究，在这些有或无哮喘的成人中分析39种合并症的患病率，并对年龄、性别、社会剥夺和吸烟史调整的前后进行分析。统计学方法使用logistic回归。
结果：在这39种合并疾病中，有36种（92%）疾病在哮喘病人中是更显著普遍存在的。62.6%的哮喘患者有≥1种疾病vs 46.2%的非哮喘人群（有≥1种疾病）;其中16.3%的哮喘人群有4种合并症VS 8.7%的非哮喘人群。在哮喘患者中更多的合并症包括:COPD(13.4% vs 3.1%)，抑郁(17.3% vs 9.1%)，痛苦(15.4% vs 8.4%)，消化不良(10.9% vs 5.2%)。在哮喘人群和非哮喘人群中最有区别的合并症如下:COPD（调整后的比值比 5.65,95%可信区间5.52-5.79）、支气管扩张症(aOR 4.65, 95%CI 4.26-5.08)、湿疹/银屑病(aOR 3.30, 95%CI 3.14-3.48)、消化不良(aOR 2.20, 95%CI 2.15-2.25)和慢性鼻窦炎(aOR 2.12, 95%CI 1.99-2.26)。抑郁和焦虑在哮喘人群中更普遍(前者aOR 1.60, 95%CI 1.57-1.63；后者 aOR 1.53, 95%CI 1.48-1.57)。
结论和临床相关性：在哮喘患者中，存在有身体和心理的合并症是常态。适当的识别以及处理应该成为日常哮喘治疗的一部分。
(中日友好医院呼吸与危重症医学科 张梦圆摘译 林江涛审校)
（Clin Exp Allergy. 2017 Jun 30. doi: 10.1111/cea.12971. [Epub ahead of print]）
（Clin Exp Allergy. 2017 Jun 30. doi: 10.1111/cea.12971. [Epub ahead of print]）
Comorbidities in adults with asthma: population-based crosssectional analysis of 1.4 million adults in Scotland
Weatherburn CJ, Guthrie B, Mercer SW, Morales DR
Abstract
Background: Comorbidity in people with asthma can significantly increase asthma morbidity and lower adherence to asthma guidelines.
Objective: The objective of this study was to comprehensively measure the prevalence of physical and mental health comorbidities in adults with asthma using a large nationally representative population.
Methods: Cross-sectional analysis of routine primary care electronic medical records for 1,424,378 adults in the UK, examining the prevalence of 39 comorbidities in people with and without asthma, before and after adjustment for age, sex, social deprivation and smoking status using logistic regression.
Results: Of 39 comorbidities measured, 36 (92%) were significantly more common in adults with asthma. 62.6% of adults with asthma had ≥1 comorbidity vs. 46.2% of those without, and 16.3% had ≥4 comorbidities vs. 8.7% of those without. Comorbidities with the largest absolute increase in prevalence in adults with asthma were: COPD (13.4% vs 3.1%), depression (17.3% vs 9.1%), painful conditions (15.4% vs 8.4%), and dyspepsia (10.9% vs 5.2%). Comorbidities with the largest relative difference in adults with asthma compared to without were: COPD (adjusted odds ratio [aOR] 5.65,95%CI 5.52-5.79), bronchiectasis (aOR 4.65, 95%CI 4.26-5.08), eczema/psoriasis (aOR 3.30, 95%CI 3.14-3.48), dyspepsia (aOR 2.20, 95%CI 2.15-2.25) and chronic sinusitis (aOR 2.12, 95%CI 1.99-2.26).Depression and anxiety were more common in adults with asthma (aOR 1.60, 95%CI 1.57-1.63, and aOR 1.53, 95%CI 1.48-1.57 respectively).
Conclusions and Clinical Relevance: Physical and mental health comorbidity is the norm in adults with asthma. Appropriate recognition and management should form part of routine asthma care.
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真实世界中哮喘-COPD 重叠综合征（ACOS）的共病，表现及影响
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年龄与哮喘表型有关
