David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Curr Opin Pulm Med. 2013 Mar;19(2):116-24. doi: 10.1097/MCP.0b013e32835d8ea4.
This article reviews findings from longitudinal observational studies in both general and chronic obstructive pulmonary disease (COPD) populations, as well as from intervention trials in COPD, in which the annual rate of decline in forced expired volume in 1 s (FEV₁) has been measured. The purpose of the review is to describe the individual variability in rates of decline in FEV₁ within these populations, explore the factors contributing to this variability and discuss its implications.
Individual rates of decline in FEV₁ have been found to vary considerably across participants with COPD in both observational cohorts and intervention trials from decreases as rapid as 150-200 ml per year to increases of up to approximately 150 ml per year, with mean rates of decline ranging from 33 to 69 ml per year. Aside from technical and biologic (e.g., time of day, season, weather, fatigue) sources of variation, other influential factors have included smoking status (most notably current versus former smoking), baseline smoking intensity, baseline lung function, airway hyperresponsiveness, exacerbation frequency, and, variably, age and sex. The presence of emphysema may also be a determinant, as well as certain biomarkers and gene variants.
The wide distribution of individual rates of decline in FEV₁ includes especially rapid and slow declines. Future research is needed to identify biomarkers that both are predictive of a rapid decline within individuals who might then be targeted for special intervention and might also serve as surrogate endpoints in interventional trials.
本文综述了在一般人群和慢性阻塞性肺疾病（COPD）人群的纵向观察性研究以及 COPD 干预试验中的研究结果，这些研究均测量了 1 秒用力呼气量（FEV₁）的年下降率。综述的目的是描述这些人群中 FEV₁ 下降率的个体差异，探讨导致这种差异的因素，并讨论其意义。
在 COPD 的观察性队列和干预试验中，FEV₁ 的个体下降率在参与者中存在很大差异，从每年快速下降 150-200 毫升到每年增加约 150 毫升不等，平均下降率范围从 33 到 69 毫升/年。除了技术和生物学（例如，一天中的时间、季节、天气、疲劳）的变化来源外，其他有影响的因素还包括吸烟状况（尤其是现在和以前吸烟）、基线吸烟强度、基线肺功能、气道高反应性、加重频率，以及年龄和性别等因素。肺气肿的存在也可能是一个决定因素，还有某些生物标志物和基因变异。
FEV₁ 个体下降率的广泛分布包括特别快速和缓慢的下降。未来需要研究识别生物标志物，这些标志物既能预测个体快速下降，又能针对那些可能需要特殊干预的个体，并能作为干预试验中的替代终点。
