Tomioka Ryusuke, Kawayama Tomotaka, Suetomo Masashi, Kinoshita Takashi, Tokunaga Yoshihisa, Imaoka Haruki, Matsunaga Kazuko, Okamoto Masaki, Hoshino Tomoaki
Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan; Respiratory Medicine, Chikugo City Hospital, Chikugo, Japan.
Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
Int J Chron Obstruct Pulmon Dis. 2016 Feb 3;11:207-16. doi: 10.2147/COPD.S98205. eCollection 2016.
The prognosis of Japanese patients with COPD who suffer repeated exacerbations is unclear, although Westerners with such episodes have a poor prognosis.
We conducted a 1-year prospective observational trial involving 90 Japanese patients with COPD: 58 nonexacerbators, 12 infrequent exacerbators, and 20 frequent exacerbators classified on the basis of exacerbation frequency (zero, one, and two or more exacerbations/year), respectively, during the previous year were observed prospectively for 1 year. The characteristics of frequent exacerbators, the frequency of exacerbation, and the period until the first event were then compared among the groups.
A total of 78 patients completed the study. Frequent exacerbators had a significantly higher risk of frequent exacerbation in the following year than the case for nonexacerbators (odds ratio [95% confidence interval] 2.94 [1.21-7.17], P=0.0340), but not in comparison with infrequent exacerbators (1.51 [0.49-4.63], P>0.05). The mean annual frequency of exacerbations in the following year was significantly (P=0.0020) higher in the frequent exacerbators (1.4 exacerbations/year) than in the nonexacerbators (0.4), but not in the infrequent exacerbators (0.9, P>0.05). The mean period until the first exacerbation was significantly shorter in the frequent exacerbators than in the infrequent or nonexacerbators (P=0.0012). Independent risk factors for future frequent exacerbation included the presence of gastroesophageal reflux disease, more severe airflow obstruction, and use of inhaled corticosteroids.
Our present results indicate that Japanese COPD patients suffering frequent exacerbation have a poor prognosis. The characteristics of Japanese and Western COPD patients suffering frequent exacerbation are similar.
尽管患有反复加重期慢性阻塞性肺疾病（COPD）的西方人预后较差，但日本患者的预后尚不清楚。
我们进行了一项为期1年的前瞻性观察试验，纳入90例日本COPD患者：根据前一年加重频率（分别为零次、一次和两次或更多次加重/年）分为58例无加重者、12例偶发加重者和20例频发加重者，对其进行为期1年的前瞻性观察。然后比较各组频发加重者的特征、加重频率以及首次事件发生前的时间。
共有78例患者完成研究。频发加重者次年频繁加重的风险显著高于无加重者（优势比[95%置信区间]2.94[1.21 - 7.17]，P = 0.0340），但与偶发加重者相比无显著差异（1.51[0.49 - 4.63]，P>0.05）。频发加重者次年的平均年加重频率（1.4次加重/年）显著高于无加重者（0.4次）（P = 0.0020），但与偶发加重者相比无显著差异（0.9次，P>0.05）。频发加重者首次加重的平均时间显著短于偶发加重者或无加重者（P = 0.0012）。未来频繁加重的独立危险因素包括胃食管反流病、更严重的气流阻塞以及吸入糖皮质激素的使用。
我们目前的结果表明，日本COPD频发加重患者预后较差。日本和西方COPD频发加重患者的特征相似。
