Oh Y-M, Sheen S-S, Park J H, Jin U R, Yoo J-W, Seo J B, Yoo K H, Lee J-H, Kim T-H, Lim S Y, Yoon H I, Lee J S, Lee S-D
Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
Int J Tuberc Lung Dis. 2014 Dec;18(12):1407-14. doi: 10.5588/ijtld.14.0205.
Frequent exacerbation is an important phenotype in chronic obstructive pulmonary disease (COPD), while emphysema is associated with many comorbidities and lung function decline.
To investigate unique features of frequent exacerbators and test the hypothesis that emphysematous phenotype is associated with frequent exacerbations of COPD.
A total of 380 COPD patients were recruited from 16 hospitals in Korea from June 2005 to April 2012 for analysis. We searched for independent predictors of frequent exacerbators in comparison with non-exacerbators.
As the severity of emphysema increased, forced expiratory volume in 1 s (FEV₁), and FEV₁/FVC (forced volume capacity) worsened; hyperinflationary features characterised by higher total lung capacity (TLC) were observed (P < 0.05). Frequent exacerbators had lower body mass index (BMI), higher St George's Respiratory Questionnaire (SGRQ) scores, higher residual volume (RV)/TLC, more severe airflow limitation (lower FEV₁ and FEV₁/FVC), lower carbon monoxide diffusion capacity, lower serum protein levels and a higher emphysema index than non-exacerbators (P < 0.05). In multivariate analysis, frequent exacerbators were independently associated with a higher emphysema index, lower serum protein levels and higher RV/TLC (P < 0.05).
Our data show that the severity of emphysema, severe static hyperinflation and serum lower protein levels are independent predictors of frequent exacerbations in COPD patients.
频繁急性加重是慢性阻塞性肺疾病（COPD）的一种重要表型，而肺气肿与多种合并症及肺功能下降相关。
探讨频繁急性加重者的独特特征，并验证肺气肿表型与COPD频繁急性加重相关这一假说。
2005年6月至2012年4月期间，从韩国16家医院招募了380例COPD患者进行分析。我们寻找频繁急性加重者相较于非急性加重者的独立预测因素。
随着肺气肿严重程度增加，1秒用力呼气容积（FEV₁）和FEV₁/FVC（用力肺活量）恶化；观察到以更高肺总量（TLC）为特征的肺过度充气表现（P<0.05）。与非急性加重者相比，频繁急性加重者的体重指数（BMI）更低、圣乔治呼吸问卷（SGRQ）评分更高、残气量（RV）/TLC更高、气流受限更严重（FEV₁和FEV₁/FVC更低）、一氧化碳弥散量更低、血清蛋白水平更低且肺气肿指数更高（P<0.05）。在多变量分析中，频繁急性加重者与更高的肺气肿指数、更低的血清蛋白水平和更高的RV/TLC独立相关（P<0.05）。
我们的数据表明，肺气肿严重程度、严重静态肺过度充气和血清低蛋白水平是COPD患者频繁急性加重的独立预测因素。
