Hersh Craig P, DeMeo Dawn L, Al-Ansari Essam, Carey Vincent J, Reilly John J, Ginns Leo C, Silverman Edwin K
Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, USA.
Chest. 2004 Nov;126(5):1443-51. doi: 10.1378/chest.126.5.1443.
Multiple risk factors for mortality in patients with COPD have been described, but most studies have involved older, primarily male subjects. The purpose of this study was to determine the mortality rate and predictors of survival in subjects with severe, early onset COPD.
DESIGN, SETTING, AND PARTICIPANTS: The cohort of 139 probands in the Boston Early-Onset COPD Study was recruited from lung transplant and general pulmonary clinics between September 1994 and July 2002. Subjects were < 53 years old, had an FEV(1) of < 40% of predicted, did not have severe alpha(1)-antitrypsin deficiency, and had not undergone lung transplantation. The initial evaluation included a standardized respiratory questionnaire, spirometry, and a blood sample. A follow-up telephone interview was conducted between May and December 2002.
Subjects were young (mean age at enrollment, 47.9 years) and had severe airflow obstruction (mean baseline FEV(1), 19.4% predicted). A total of 72.7% of the subjects were women (p < 0.0001 [comparison to equal gender distribution]). The median estimated survival time was 7.0 years from the time of study enrollment, determined by the Kaplan-Meier method. The majority of deaths were due to cardiorespiratory illness. In a multivariable Cox proportional hazards model, adjusting for age, gender, and baseline FEV(1), lifetime cigarette consumption (hazard ratio [HR], 1.20 [per 10 pack-years]; 95% confidence interval [CI], 1.02 to 1.40) and recent smoking status (HR, 2.50; 95% CI, 1.03 to 6.05) were both significant predictors of mortality.
In this cohort, recent smoking status predicted increased mortality independent of the effects of lifetime smoking intensity. Smoking cessation may confer a survival benefit even among patients with very severe COPD.
慢性阻塞性肺疾病（COPD）患者的多种死亡风险因素已被描述，但大多数研究涉及的是年龄较大、主要为男性的受试者。本研究的目的是确定重度早发型COPD患者的死亡率和生存预测因素。
设计、地点和参与者：波士顿早发型COPD研究中的139名先证者队列于1994年9月至2002年7月从肺移植和普通肺病诊所招募。受试者年龄小于53岁，第一秒用力呼气容积（FEV₁）低于预测值的40%，无严重α₁-抗胰蛋白酶缺乏症，且未接受过肺移植。初始评估包括标准化呼吸问卷、肺功能测定和血液样本。2002年5月至12月进行了随访电话访谈。
受试者年轻（入组时平均年龄47.9岁），有严重气流阻塞（平均基线FEV₁为预测值的19.4%）。共有72.7%的受试者为女性（p<0.0001[与性别均等分布相比]）。根据Kaplan-Meier方法，从研究入组时间起的中位估计生存时间为7.0年。大多数死亡是由于心肺疾病。在多变量Cox比例风险模型中，调整年龄、性别和基线FEV₁后，终生吸烟量（风险比[HR]，1.20[每10包年]；95%置信区间[CI]，1.02至1.40）和近期吸烟状态（HR，2.50；95%CI，1.03至6.05）均为死亡率的显著预测因素。
在该队列中，近期吸烟状态可预测死亡率增加，且独立于终生吸烟强度的影响。即使在非常严重的COPD患者中，戒烟也可能带来生存益处。
