COPDGene 研究中低氧血症和氧疗的临床和影像学相关性。
Clinical and radiographic correlates of hypoxemia and oxygen therapy in the COPDGene study.
机构信息
Channing Laboratory, Brigham and Women's Hospital, Boston, MA 02115, USA.
出版信息
Respir Med. 2011 Aug;105(8):1211-21. doi: 10.1016/j.rmed.2011.02.015. Epub 2011 Mar 10.
BACKGROUND
Severe hypoxemia is a major complication of chronic obstructive pulmonary disease (COPD). Long-term oxygen therapy is beneficial in hypoxemic COPD patients. However, the clinical and radiographic predictors of hypoxemia and the use of oxygen therapy are not well described. This study aimed to find the correlates of resting hypoxemia and the pattern of oxygen use in moderate to severe COPD patients.
METHODS
Subjects with GOLD stage II or higher COPD from the first 2500 COPDGene subjects were included in this analysis. All subjects were current or ex-smokers between ages 45 and 80. Severe resting hypoxemia was defined as room air oxygen saturation (SpO(2)) ≤88%. Use of supplemental oxygen therapy was determined by questionnaire.
RESULTS
Eighty-two of 1060 COPD subjects (7.7%) had severe resting hypoxemia. Twenty-one of the 82 (25.6%) were not using continuous supplemental oxygen. Female sex, higher BMI, lower FEV(1), and enrollment in Denver were independent risk factors for hypoxemia; emphysema severity on quantitative chest CT scan did not predict hypoxemia. 132 of 971(13.6%) subjects without severe resting hypoxemia were using continuous supplemental oxygen. In non-hypoxemic oxygen users, Denver recruitment, higher BMI, lower FEV(1), and more severe dyspnea were associated with the use of continuous oxygen.
CONCLUSIONS
A large number of COPD patients without severe hypoxemia were using supplemental oxygen therapy and the pattern of oxygen use was affected by factors other than resting SpO(2) and emphysema severity. Longitudinal data will be required to reveal the effects of oxygen therapy in this subgroup.
CLINICAL TRIAL REGISTRATION
http://clinicaltrials.gov (NCT00608764).
背景
严重低氧血症是慢性阻塞性肺疾病（COPD）的主要并发症。长期氧疗对低氧血症 COPD 患者有益。然而，低氧血症的临床和影像学预测因素以及氧疗的应用尚不清楚。本研究旨在寻找中重度 COPD 患者静息低氧血症和氧疗模式的相关因素。
方法
从 COPDGene 研究的前 2500 名受试者中纳入 GOLD 分期 II 级或更高级别的 COPD 患者。所有受试者均为年龄在 45 至 80 岁之间的当前或曾经吸烟者。严重静息性低氧血症定义为空气氧饱和度（SpO2）≤88%。通过问卷确定补充氧疗的使用情况。
结果
在 1060 名 COPD 患者中，有 82 名（7.7%）患有严重静息性低氧血症。其中 21 名（25.6%）未使用持续补充氧气。女性、较高的 BMI、较低的 FEV1 和在丹佛入组是低氧血症的独立危险因素；定量胸部 CT 扫描上的肺气肿严重程度不能预测低氧血症。在 971 名无严重静息性低氧血症的患者中，有 132 名（13.6%）正在使用持续补充氧气。在非低氧血症氧使用者中，丹佛招募、较高的 BMI、较低的 FEV1 和更严重的呼吸困难与持续吸氧有关。
结论
大量无严重低氧血症的 COPD 患者正在使用补充氧疗，氧疗模式受到除静息 SpO2 和肺气肿严重程度以外的因素影响。需要进行纵向数据研究才能揭示该亚组中氧疗的效果。
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