慢性阻塞性肺疾病 (COPD)

最重要的危险因素。[10]Li X, Cao X, Guo M, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017. BMJ. 2020 Feb 19;368:m234. https://www.doi.org/10.1136/bmj.m234 http://www.ncbi.nlm.nih.gov/pubmed/32075787?tool=bestpractice.com 约 40%-70% 的 COPD 病例由吸烟导致。[9]Raherison C, Girodet PO. Epidemiology of COPD. Eur Respir Rev. 2009 Dec;18(114):213-21. http://err.ersjournals.com/content/18/114/213.long http://www.ncbi.nlm.nih.gov/pubmed/20956146?tool=bestpractice.com 暴露于二手烟也会增加罹患 COPD 的风险。

引起炎症反应并导致纤毛功能障碍和氧化损伤

年龄的影响可能与吸烟时间更长以及正常年龄相关的 FEV1 下降相关

对吸入性刺激物的气道反应性取决于遗传因素。α-1 抗胰蛋白酶缺乏是一种遗传性疾病，最常发生在北欧血统人群中，这种疾病会导致在年轻时出现下肺叶的全肺泡性气肿。 一项系统评价和荟萃分析表明，在 COPD 患者成年子女中，COPD 的患病率高于基于人群的估计值。[18]Li LS, Paquet C, Johnston K, et al. "What are my chances of developing COPD if one of my parents has the disease?" A systematic review and meta-analysis of prevalence of co-occurrence of COPD diagnosis in parents and offspring. Int J Chron Obstruct Pulmon Dis. 2017 Jan 24;12:403-15. https://www.dovepress.com/ldquowhat-are-my-chances-of-developing-copd-if-one-of-my-parents-has-t-peer-reviewed-fulltext-article-COPD http://www.ncbi.nlm.nih.gov/pubmed/28182144?tool=bestpractice.com

在校正吸烟、年龄、性别和社会经济地位等因素之后，发现 COPD 在白人中比在黑人和南亚人中常见。[19]Gilkes A, Hull S, Durbaba S, et al. Ethnic differences in smoking intensity and COPD risk: an observational study in primary care. NPJ Prim Care Respir Med. 2017 Sep 4;27(1):50. https://www.doi.org/10.1038/s41533-017-0052-8 http://www.ncbi.nlm.nih.gov/pubmed/28871087?tool=bestpractice.com

长期暴露于粉尘、交通废气和二氧化硫，增加 COPD 的发生风险。[10]Li X, Cao X, Guo M, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017. BMJ. 2020 Feb 19;368:m234. https://www.doi.org/10.1136/bmj.m234 http://www.ncbi.nlm.nih.gov/pubmed/32075787?tool=bestpractice.com

在家暴露于燃烧的煤炭或生物质燃料会增加罹患 COPD 的风险。[20]Chan KH, Kurmi OP, Bennett DA, et al. Solid fuel use and risks of respiratory diseases. A cohort study of 280,000 Chinese never-smokers. Am J Respir Crit Care Med. 2019 Feb 1;199(3):352-61. https://www.doi.org/10.1164/rccm.201803-0432OC http://www.ncbi.nlm.nih.gov/pubmed/30235936?tool=bestpractice.com

在所有 COPD 病例中，约有 14％ 归因于职业暴露。[21]Blanc PD, Annesi-Maesano I, Balmes JR, et al. The occupational burden of nonmalignant respiratory diseases. An official American Thoracic Society and European Respiratory Society statement. Am J Respir Crit Care Med. 2019 Jun 1;199(11):1312-34. https://www.doi.org/10.1164/rccm.201904-0717ST http://www.ncbi.nlm.nih.gov/pubmed/31149852?tool=bestpractice.com

幼儿时期反复感染可能导致肺部瘢痕形成、弹性下降，从而增加罹患 COPD 的风险。结核病病史与 COPD 发生风险增加有关。[22]Bellou V, Belbasis L, Konstantinidis AK, et al. Elucidating the risk factors for chronic obstructive pulmonary disease: an umbrella review of meta-analyses. Int J Tuberc Lung Dis. 2019 Jan 1;23(1):58-66. http://www.ncbi.nlm.nih.gov/pubmed/30674376?tool=bestpractice.com

COPD 在男性中更为常见，可能是因为男性吸烟者更多。然而，有证据显示女性对吸烟影响的易感性可能高于男性。[23]Xu X, Weiss ST, Rijcken B, et al. Smoking, changes in smoking habits, and rate of decline in FEV1: new insight into gender differences. Eur Respir J. 1994 Jun;7(6):1056-61. http://erj.ersjournals.com/content/erj/7/6/1056.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/7925873?tool=bestpractice.com [24]Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994 Nov 16;272(19):1497-505. http://www.ncbi.nlm.nih.gov/pubmed/7966841?tool=bestpractice.com [25]Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 Dec;162(6):2152-8. https://www.atsjournals.org/doi/full/10.1164/ajrccm.162.6.2003112 http://www.ncbi.nlm.nih.gov/pubmed/11112130?tool=bestpractice.com [26]Calverley PM, Anderson JA, Celli B. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007 Feb 22;356(8):775-89. https://www.nejm.org/doi/full/10.1056/NEJMoa063070 http://www.ncbi.nlm.nih.gov/pubmed/17314337?tool=bestpractice.com

低社会经济地位的人群慢阻肺的发生风险增加。[27]Prescott E, Lange P, Vestbo J. Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study. Eur Respir J. 1999 May;13(5):1109-14. http://erj.ersjournals.com/content/erj/13/5/1109.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/10414412?tool=bestpractice.com 但是，这可能反映了吸烟、污染物或其他暴露因素。

流行病学研究表明，COPD 风险与类风湿性关节炎病史之间存在关联。[22]Bellou V, Belbasis L, Konstantinidis AK, et al. Elucidating the risk factors for chronic obstructive pulmonary disease: an umbrella review of meta-analyses. Int J Tuberc Lung Dis. 2019 Jan 1;23(1):58-66. http://www.ncbi.nlm.nih.gov/pubmed/30674376?tool=bestpractice.com 一项 meta 分析显示，与对照组相比，类风湿性关节炎患者新发 COPD 的风险显著增加，总体相对危险度为 1.82。[28]Ma Y, Tong H, Zhang X, et al. Chronic obstructive pulmonary disease in rheumatoid arthritis: a systematic review and meta-analysis. Respir Res. 2019 Jul 9;20(1):144. https://www.doi.org/10.1186/s12931-019-1123-x http://www.ncbi.nlm.nih.gov/pubmed/31288799?tool=bestpractice.com