1Division of Pulmonology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. USA.
Pediatr Pulmonol. 2010 Feb;45(2):127-34. doi: 10.1002/ppul.21117.
Lung function (FEV(1)) generally improves during treatment of pulmonary exacerbations in patients with cystic fibrosis (CF). However, it is unclear how often return to previous baseline FEV(1) is achieved.
(1) To determine the proportion of pediatric patients with CF treated for a pulmonary exacerbation who fail to recover to baseline FEV(1) and (2) to identify factors associated with this failure.
We performed a case-control analysis of patients from a single pediatric CF center admitted for their first pulmonary exacerbation in 2001-2006. Patients were considered to have recovered to baseline FEV(1) if their best FEV(1) within the 3 months following treatment was >or=95% of the best FEV(1) during the 6 months prior to treatment. Logistic regression was used to estimate associations between clinical characteristics and failure to regain baseline FEV(1).
Of 104 patients, 24 (23.1%) did not recover to baseline FEV(1). The adjusted odds ratio of failure to recover to baseline FEV(1) was 1.49 (95% confidence interval [CI] 1.20, 1.86) for every 5% greater decline in FEV(1) from baseline to admission. In exploratory analyses, the adjusted odds ratios for the failure to recover to baseline were also significantly higher for patients who were evaluated in our CF clinic more frequently between the baseline measurement and admission, were younger, or were insured by Medicaid.
Approximately one in four patients with CF failed to recover to baseline lung function after a pulmonary exacerbation despite treatment with intravenous antibiotics. Failure to recover to baseline was associated with the degree of decline in FEV(1) that had occurred prior to hospital admission, suggesting opportunities for earlier intervention to improve lung function outcomes. Additional studies are needed to determine how the failure to recover to baseline affects subsequent FEV(1) decline.
在囊性纤维化（CF）患者的肺部感染恶化的治疗过程中，肺功能（FEV1）通常会改善。然而，目前尚不清楚有多少患者能恢复到先前的 FEV1 基线水平。
（1）确定因肺部感染恶化而接受治疗的 CF 儿科患者中，未能恢复到 FEV1 基线水平的比例；（2）确定与这种失败相关的因素。
我们对 2001 年至 2006 年间在单一儿科 CF 中心因首次肺部感染恶化而入院的患者进行了病例对照分析。如果患者在治疗后 3 个月内的最佳 FEV1 大于或等于治疗前 6 个月内最佳 FEV1 的 95%，则认为其已恢复到 FEV1 基线水平。采用逻辑回归来估计临床特征与未能恢复 FEV1 基线水平之间的相关性。
在 104 例患者中，有 24 例（23.1%）未能恢复到 FEV1 基线水平。FEV1 从基线到入院时的下降幅度每增加 5%，则无法恢复到 FEV1 基线水平的调整后比值比为 1.49（95%置信区间 [CI]，1.20 至 1.86）。在探索性分析中，与基线测量和入院之间在 CF 门诊接受评估更频繁、年龄更小或由医疗补助计划承保的患者相比，无法恢复到 FEV1 基线水平的调整后比值比也显著更高。
尽管接受了静脉注射抗生素治疗，但约有 1/4 的 CF 患者在肺部感染恶化后未能恢复到肺功能的基线水平。无法恢复到基线水平与入院前 FEV1 下降的程度有关，这表明有机会进行更早的干预以改善肺功能结局。需要进一步的研究来确定无法恢复到基线水平对随后的 FEV1 下降有何影响。
