Sanders Don B, Li Zhanhai, Zhao Qianqian, Farrell Philip M
Department of Pediatrics, Riley Hospital for Children, School of Medicine, Indiana University, Indiana, IN, USA.
Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
J Cyst Fibros. 2017 Jul 29. doi: 10.1016/j.jcf.2017.07.003.
Patients with CF treated for pulmonary exacerbations (PEx) may experience faster subsequent declines in FEV. Additionally, incomplete recovery to baseline FEV occurs frequently following PEx treatment. Whether accelerated declines in FEV are preceded by poor PEx recovery has not been studied.
Using 2004 to 2011 CF Foundation Patient Registry data, we randomly selected one PEx among patients ≥6years of age with no organ transplantations, ≥12months of data before and after the PEx, and ≥1 FEV recorded within the 6months before and 3months after the PEx. We defined poor PEx recovery as the best FEV in the 3months after the PEx <90% of the best FEV in the 6months before the PEx. We calculated mean (95% CI) hazard ratios (HR) of having >5% predicted/year FEV decline and poor PEx recovery using multi-state Markov models.
From 13,954 PEx, FEV declines of >5% predicted/year were more likely to precede poor spirometric recovery, HR 1.17 (1.08, 1.26), in Markov models adjusted for age and sex. Non-Responders were less likely to have a subsequent fast FEV decline, HR 0.41 (0.37, 0.46), than patients who recovered to >90% of baseline FEV following PEx treatment.
Accelerated declines in FEV are more likely to precede a PEx with poor recovery than to occur in the following year. Preventing or halting declines in FEV may also have the benefit of preventing PEx episodes.
接受肺部加重期（PEx）治疗的囊性纤维化（CF）患者，其后续的第一秒用力呼气容积（FEV）可能会更快下降。此外，PEx治疗后FEV经常无法完全恢复到基线水平。FEV加速下降是否先于PEx恢复不佳尚未得到研究。
利用2004年至2011年CF基金会患者注册数据，我们在≥6岁、未接受器官移植、PEx前后有≥12个月数据且PEx前6个月和后3个月内记录有≥1次FEV的患者中随机选择一次PEx。我们将PEx恢复不佳定义为PEx后3个月内的最佳FEV < PEx前6个月内最佳FEV的90%。我们使用多状态马尔可夫模型计算预测每年FEV下降>5%和PEx恢复不佳的平均（95%置信区间）风险比（HR）。
在13954次PEx中，在根据年龄和性别调整的马尔可夫模型中，预测每年FEV下降>5%更有可能先于肺功能恢复不佳，HR为1.17（1.08，1.26）。与PEx治疗后恢复到基线FEV的>90%的患者相比，无反应者随后FEV快速下降的可能性较小，HR为0.41（0.37，0.46）。
FEV加速下降更有可能先于恢复不佳的PEx出现，而不是在次年发生。预防或阻止FEV下降也可能有助于预防PEx发作。
