Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Eur Respir J. 2017 Nov 9;50(5). doi: 10.1183/13993003.00326-2017. Print 2017 Nov.
With the advent of novel designer molecules for cystic fibrosis (CF) treatment, there is huge need for early-life clinical trial outcomes, such as infant lung function (ILF). We investigated the degree and tracking of ILF abnormality during the first 2 years of life in CF newborn screened infants.Forced expiratory volume in 0.5 s (FEV), lung clearance index (LCI) and plethysmographic functional residual capacity were measured at ∼3 months, 1 year and 2 years in 62 infants with CF and 34 controls.By 2 years there was no significant difference in FEV z-score between CF and controls, whereas mean LCI z-score was 0.81 (95% CI 0.45-1.17) higher in CF. However, there was no significant association between LCI z-score at 2 years with either 3-month or 1-year results. Despite minimal average group changes in any ILF outcome during the second year of life, marked within-subject changes occurred. No child had abnormal LCI or FEV on all test occasions, precluding the ability to identify "high-risk" infants in early life.In conclusion, changes in lung function are mild and transient during the first 2 years of life in newborn screened infants with CF when managed according to a standardised UK treatment protocol. Their potential role in tracking disease to later childhood will be ascertained by ongoing follow-up.
随着新型设计分子用于囊性纤维化 (CF) 治疗的出现,对婴儿期临床试验结果(如婴儿肺功能 (ILF))的需求巨大。我们调查了在 CF 新生儿筛查婴儿的前 2 年中 ILF 异常的程度和跟踪情况。在 62 名 CF 婴儿和 34 名对照婴儿中,在大约 3 个月、1 岁和 2 岁时测量了 0.5 秒用力呼气量 (FEV)、肺清除指数 (LCI) 和体描法功能残气量。到 2 岁时,CF 和对照组之间的 FEV z 评分没有显著差异,而 CF 的平均 LCI z 评分高 0.81(95% CI 0.45-1.17)。然而,2 岁时的 LCI z 评分与 3 个月或 1 岁时的结果均无显著相关性。尽管在生命的第二年中任何 ILF 结果的平均组变化都很小,但个体内的变化很大。没有孩子在所有测试时都有异常的 LCI 或 FEV,从而无法识别早期生活中的“高危”婴儿。总之,在按照标准化的英国治疗方案管理时,CF 新生儿筛查婴儿在生命的前 2 年中肺功能的变化是轻微和短暂的。他们在跟踪疾病进入后期儿童期的潜在作用将通过正在进行的随访来确定。