First Department of Medicine, Hokkaido University School of Medicine, and Center for Respiratory Diseases, Hokkaido Social Insurance Hospital, N-15 W-7, Kita-ku, Sapporo 060-8638, Japan.
Am J Respir Crit Care Med. 2012 Jan 1;185(1):44-52. doi: 10.1164/rccm.201106-0992OC.
Although the rate of annual decline in FEV1 is one of the most important outcome measures in chronic obstructive pulmonary disease (COPD), little is known about intersubject variability based on clinical phenotypes.
To examine the intersubject variability in a 5-year observational cohort study, particularly focusing on emphysema severity.
A total of 279 eligible patients with COPD (stages I-IV: 26, 45, 24, and 5%) participated. We conducted a detailed assessment of pulmonary function and computed tomography (CT) at baseline, and performed spirometry every 6 months before and after inhalation of bronchodilator. Smoking status, exacerbation, and pharmacotherapy were carefully monitored. Emphysema severity was evaluated by CT and annual measurements of carbon monoxide transfer coefficient.
Using mixed effects model analysis, the annual decline in post-bronchodilator FEV1 was -32±24 (SD) ml/yr (n=261). We classified the subjects of less than the 25th percentile as Rapid decliners, the 25th to 75th percentile as Slow decliners, and greater than the 75th percentile as Sustainers (-63±2, -31±1, and -2±1 [SE] ml/yr). Emphysema severity, but not %FEV1, showed significant differences among the three groups. Multiple logistic regression analysis demonstrated that the Rapid decliners were independently associated with emphysema severity assessed either by CT or carbon monoxide transfer coefficient. The Sustainers displayed less emphysema and higher levels of circulating eosinophils.
Emphysema severity is independently associated with a rapid annual decline in FEV1 in COPD. Sustainers and Rapid decliners warrant specific attention in clinical practice.
虽然用力肺活量（FEV1）的年下降率是慢性阻塞性肺疾病（COPD）最重要的结局指标之一，但基于临床表型的受试者间变异性知之甚少。
在一项为期 5 年的观察性队列研究中，检查受试者间变异性，尤其是关注肺气肿严重程度。
共有 279 名符合条件的 COPD 患者（I-IV 期分别为 26%、45%、24%和 5%）参与了该研究。我们在基线时进行了详细的肺功能和计算机断层扫描（CT）评估，并在吸入支气管扩张剂前后每 6 个月进行一次肺功能检查。吸烟状况、加重情况和药物治疗情况进行了密切监测。肺气肿严重程度通过 CT 和一氧化碳传递系数的年度测量进行评估。
使用混合效应模型分析，支气管扩张剂后 FEV1 的年下降率为-32±24（SD）ml/yr（n=261）。我们将低于第 25 百分位数的受试者分类为快速下降者，第 25 至 75 百分位数的为缓慢下降者，大于第 75 百分位数的为持续者（-63±2、-31±1 和-2±1[SE]ml/yr）。三组间肺气肿严重程度差异有统计学意义，但 %FEV1 无差异。多因素逻辑回归分析显示，快速下降者与 CT 或一氧化碳传递系数评估的肺气肿严重程度独立相关。持续者表现出较少的肺气肿和较高水平的循环嗜酸性粒细胞。
肺气肿严重程度与 COPD 患者 FEV1 的快速年下降独立相关。持续者和快速下降者在临床实践中需要特别关注。
