有哮喘和无哮喘受试者持续性气流受限的病程。
The course of persistent airflow limitation in subjects with and without asthma.
作者信息
Guerra Stefano, Sherrill Duane L, Kurzius-Spencer Margaret, Venker Claire, Halonen Marilyn, Quan Stuart F, Martinez Fernando D
机构信息
Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA.
出版信息
Respir Med. 2008 Oct;102(10):1473-82. doi: 10.1016/j.rmed.2008.04.011. Epub 2008 Aug 6.
RATIONALE
Most patients who develop persistent airflow limitation do so either as a manifestation of chronic obstructive pulmonary disease that is largely related to smoking or as a consequence of persistent asthma. We sought to compare the natural course of lung function associated with persistent airflow limitation in subjects with and without asthma from early to late adult life.
METHODS
We studied 2552 participants aged 25 or more who had multiple questionnaire and lung function data from the long-term prospective population-based Tucson Epidemiological Study of Airway Obstructive Disease. Persistent airflow limitation was defined as FEV(1)/FVC ratio consistently < 70% in all completed surveys subsequent to the first survey with airflow limitation. Participants were divided into nine groups based on the combination of their physician-confirmed asthma status (never, onset < or = 25 years, or onset > 25 years) and the presence of airflow limitation during the study follow-up (never, inconsistent, or persistent).
RESULTS
Among subjects with an asthma onset < or = 25 years, blood eosinophilia increased significantly the odds of developing persistent airflow limitation (adjusted ORs: 3.7, 1.4-9.5), whereas cigarette smoking was the strongest risk factor for persistent airflow limitation among non-asthmatics and among subjects with asthma onset after age 25 years. Among subjects with persistent airflow limitation, the natural course of lung function differed between subjects with asthma onset < or = 25 years and non-asthmatics, with the former having lower FEV(1) levels at age 25 (predicted value for a 175-cm tall male of 3400 versus 4090 ml, respectively; p<0.001) and the latter having greater FEV(1) loss between age 25 and 75 (1590 versus 2140 ml; p=0.003).
CONCLUSION
In subjects who have asthma onset before 25 years of age and persistent airflow limitation in adult life, the bulk of the FEV(1) deficit is already established before age 25 years.
原理
大多数出现持续性气流受限的患者，其气流受限要么是慢性阻塞性肺疾病的一种表现，而这在很大程度上与吸烟有关，要么是持续性哮喘的结果。我们试图比较有哮喘和无哮喘的受试者从成年早期到晚期与持续性气流受限相关的肺功能自然病程。
方法
我们研究了2552名年龄在25岁及以上的参与者，他们来自基于人群的长期前瞻性图森气道阻塞性疾病流行病学研究，拥有多份问卷和肺功能数据。持续性气流受限被定义为在首次出现气流受限的调查之后，所有完成的调查中FEV(1)/FVC比值持续<70%。参与者根据医生确认的哮喘状态（从未有过、发病年龄≤25岁或发病年龄>25岁）以及研究随访期间气流受限的情况（从未有过、不持续或持续）进行分组，共分为九组。
结果
在哮喘发病年龄≤25岁的受试者中，血液嗜酸性粒细胞增多显著增加了发生持续性气流受限的几率（校正后的比值比：3.7，1.4 - 9.5），而吸烟是无哮喘者以及哮喘发病年龄在25岁之后的受试者中持续性气流受限的最强危险因素。在有持续性气流受限的受试者中，哮喘发病年龄≤25岁的受试者与无哮喘者的肺功能自然病程有所不同，前者在25岁时FEV(1)水平较低（身高175厘米男性的预测值分别为3400与4090毫升；p<0.001），而后者在25岁至75岁之间FEV(1)下降幅度更大（1590与2140毫升；p = 0.003）。
结论
在25岁之前发病且成年后出现持续性气流受限的受试者中，FEV(1)的大部分 deficit 在25岁之前就已形成。 （注：此处“deficit”可能是“降低、不足”等意思，结合前文推测可能是指FEV(1)的降低幅度等情况，但原英文中未明确给出准确含义）
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