Cardio-Thoracic and Vascular Department, University of Pisa, Italy.
Respir Med. 2009 Aug;103(8):1224-30. doi: 10.1016/j.rmed.2009.01.023. Epub 2009 Mar 21.
To identify predictors of success for an 8week pulmonary rehabilitation programme (PRP) in patients with chronic obstructive pulmonary disease (COPD).
Sixty patients were stratified in subgroups according to baseline findings: airway obstruction (FEV(1) >/= or <50% pred), pulmonary hyperinflation (TLC > or <or=120% pred), BMI value (BMI > or <or=25), cardiovascular (CV) comorbidity, and resting PaO(2) (PaO(2) >/= or <60mmHg). Outcome measurements of PRP were: >54m increase in 6min walking test (6MWT), or >4points reduction in total score of S. George Respiratory Questionnaire (SGRQ). Logistic regression analysis was used.
After PRP there was a significant improvement in exercise tolerance and quality of life, which correlated with baseline FEV(1)/VC, PaO(2), SpO(2), 6MWT and SGRQ. SGRQ significantly decreased and 6MWT significantly increased after PRP in all subgroups, except for patients with CV comorbidities. Both univariate and multivariate logistic regression analyses showed that BMI>25 and resting PaO(2)<60mmHg were independent predictors of PRP efficacy in terms of improvement of 6MWT, but not of SGRQ scores.
Clinical and functional baseline findings do not predict the response to PRP in COPD. The greater efficacy in patients with BMI>25 or with PaO(2)<60mmHg may be due to a greater deconditioning in overweight patients, and to a larger room for improvement in hypoxemic patients.
确定慢性阻塞性肺疾病（COPD）患者 8 周肺康复计划（PRP）成功的预测因素。
根据基线发现，将 60 名患者分为亚组：气道阻塞（FEV1≥或<50%预测值）、肺过度充气（TLC≥或<120%预测值）、BMI 值（BMI≥或<25）、心血管（CV）合并症和静息 PaO2（PaO2≥或<60mmHg）。PRP 的结果测量包括：6 分钟步行试验（6MWT）增加>54m，或 S. George 呼吸问卷（SGRQ）总分降低>4 分。使用逻辑回归分析。
PRP 后，运动耐量和生活质量均有显著改善，与基线 FEV1/VC、PaO2、SpO2、6MWT 和 SGRQ 相关。除 CV 合并症患者外，所有亚组的 SGRQ 评分均显著降低，6MWT 评分均显著升高。单变量和多变量逻辑回归分析显示，BMI>25 和静息 PaO2<60mmHg 是 PRP 改善 6MWT 疗效的独立预测因素，但不是 SGRQ 评分的独立预测因素。
临床和功能基线发现不能预测 COPD 对 PRP 的反应。BMI>25 或 PaO2<60mmHg 的患者疗效更好，可能是由于超重患者的去适应程度更大，以及低氧血症患者的改善空间更大。
