Cohen Judith, Postma Dirkje S, Vink-Klooster Karin, van der Bij Wim, Verschuuren Erik, Ten Hacken Nick H T, Koëter Gerard H, Douma W Rob
Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Chest. 2007 Oct;132(4):1198-203. doi: 10.1378/chest.06-2763. Epub 2007 Sep 21.
The ratio of FVC to slow inspiratory vital capacity (SVC) has been reported to reflect small airways obstruction, but its validity as such is still unclear. The aim of this study was to assess the applicability of the FVC/SVC ratio as a marker of small airways function in patients with bronchiolitis obliterans syndrome (BOS) after lung transplantation (LTX), which is a disorder in which predominantly small airways obstruction causes progressive airflow limitation.
The FVC/SVC ratio was analyzed both cross-sectionally and longitudinally in 39 patients (26 men) with BOS after bilateral LTX (median age, 47 years; interquartile range [IQR], 35 to 54 years), and 36 bilateral lung transplant recipients without BOS (14 men; median age, 46 years; IQR, 41 to 53 years).
The FVC/SVC ratio decreased significantly during follow-up in patients with BOS stages 1 and 2, by 2.2% and 4.4%, respectively, from baseline (p < 0.001). This decrease was not significantly associated with the decrease in FEV(1). The FVC/SVC ratio increased, though not significantly, in the group in which BOS did not develop by 1.1%, which is a significant difference from the average fall of 4.4% in the group in which BOS developed.
Significant, yet small decreases in FVC/SVC ratio occur in patients in whom BOS develops, independent from changes in FEV(1). At a group level, FVC/SVC ratio is able to detect small airways changes. These results merit prospective studies to determine the sensitivity of FVC/SVC ratio to quantifying small airways dysfunction at an individual level and in other airway diseases.
据报道，用力肺活量（FVC）与慢吸气肺活量（SVC）的比值可反映小气道阻塞情况，但其作为此类指标的有效性仍不明确。本研究旨在评估FVC/SVC比值作为肺移植（LTX）后闭塞性细支气管炎综合征（BOS）患者小气道功能标志物的适用性，BOS是一种主要由小气道阻塞导致进行性气流受限的疾病。
对39例双侧LTX后发生BOS的患者（26例男性）和36例未发生BOS的双侧肺移植受者（14例男性）进行了FVC/SVC比值的横断面和纵向分析。发生BOS的患者中位年龄47岁（四分位间距[IQR]，35至54岁），未发生BOS的患者中位年龄46岁（IQR，41至53岁）。
在1期和2期BOS患者的随访期间，FVC/SVC比值从基线水平分别显著下降了2.2%和4.4%（p<0.001）。这种下降与第1秒用力呼气容积（FEV₁）的下降无显著相关性。在未发生BOS的组中，FVC/SVC比值虽未显著升高，但升高了1.1%，这与发生BOS组平均下降4.4%有显著差异。
发生BOS的患者FVC/SVC比值出现显著但较小幅度的下降，且与FEV₁的变化无关。在组水平上，FVC/SVC比值能够检测到小气道的变化。这些结果值得进行前瞻性研究，以确定FVC/SVC比值在个体水平和其他气道疾病中量化小气道功能障碍的敏感性。
