Kim Soo Jung, Lee Jinwoo, Park Young Sik, Lee Chang-Hoon, Yoon Ho Il, Lee Sang-Min, Yim Jae-Joon, Kim Young Whan, Han Sung Koo, Yoo Chul-Gyu
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
Int J Chron Obstruct Pulmon Dis. 2015 Dec 30;11:51-60. doi: 10.2147/COPD.S95028. eCollection 2016.
According to the Fletcher-Peto curve, rate of decline in forced expiratory volume in 1-second (FEV1) accelerates as age increases. However, recent studies have not demonstrated that the rate of FEV1 decline accelerates with age among COPD patients. The objective of the study is to evaluate annual rate of FEV1 decline as age increases among COPD patients.
In this retrospective cohort study, we enrolled COPD patients who were followed up at two tertiary care university hospitals from January 2000 to August 2013. COPD was defined as post-bronchodilator (BD) FEV1/forced vital capacity (FVC) of <0.7. All participants had more than two spirometries, including BD response. Age groups were categorized as follows: below versus above median age or four quartiles.
A total of 518 participants (94.2% male; median age, 67 years; range, 42-90 years) were included. Mean absolute and predictive values of post-BD FEV1 were 1.57±0.62 L and 52.53%±18.29%, respectively. Distribution of Global initiative for Chronic Obstructive Lung Disease groups did not show statistical differences between age groups categorized by two different criteria. After grouping the population by age quartiles, the rate of FEV1 decline was faster among older patients than younger ones whether expressed as absolute value (-10.60±5.57 mL/year, -15.84±6.01 mL/year, -18.63±5.53 mL/year, 32.94±6.01 mL/year, respectively; P=0.048) or predicted value (-0.34%±0.19%/year, -0.53%±0.21%/year, -0.62%±0.19%/year, -1.26%±0.21%/year, respectively, P=0.010).
As suggested conceptually by the Fletcher-Peto curve, annual FEV1 decline among COPD patients is accelerated among older patients than younger ones.
根据弗莱彻 - 佩托曲线，一秒用力呼气容积（FEV1）的下降速率随年龄增长而加快。然而，最近的研究并未证明慢性阻塞性肺疾病（COPD）患者中FEV1的下降速率会随年龄增长而加快。本研究的目的是评估COPD患者中随着年龄增长FEV1的年下降速率。
在这项回顾性队列研究中，我们纳入了2000年1月至2013年8月在两家三级医疗大学医院接受随访的COPD患者。COPD定义为支气管扩张剂（BD）后FEV1/用力肺活量（FVC）<0.7。所有参与者均进行了两次以上的肺功能测试，包括BD反应。年龄组分类如下：低于与高于年龄中位数或四个四分位数。
共纳入518名参与者（男性占94.2%；年龄中位数为67岁；范围为42 - 90岁）。BD后FEV1的平均绝对值和预测值分别为1.57±0.62 L和52.53%±18.29%。慢性阻塞性肺疾病全球倡议组织分组在按两种不同标准分类的年龄组之间未显示出统计学差异。按年龄四分位数对人群进行分组后，无论以绝对值（分别为-10.60±5.57 mL/年，-15.84±6.01 mL/年，-18.63±5.53 mL/年，-32.94±6.01 mL/年；P = 0.048）还是预测值（分别为-0.34%±0.19%/年，-0.53%±0.21%/年，-0.62%±0.19%/年，-1.26%±0.21%/年，P = 0.010）表示，老年患者中FEV1的下降速率均比年轻患者更快。
正如弗莱彻 - 佩托曲线在概念上所提示的，COPD患者中，老年患者的FEV1年下降速率比年轻患者更快。
