在纤维化性间质性肺疾病中，运动性低氧血症比 COPD 更严重。

Exertional hypoxemia is more severe in fibrotic interstitial lung disease than in COPD.

机构信息

Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.

出版信息

Respirology. 2018 Apr;23(4):392-398. doi: 10.1111/resp.13226. Epub 2017 Nov 28.

DOI:10.1111/resp.13226

PMID:29193512

Abstract

BACKGROUND AND OBJECTIVE

Despite its clinical and prognostic significance, few studies have evaluated the severity of exertional oxygen desaturation in fibrotic interstitial lung disease (ILD). Our objectives were to identify clinical and physiological variables that predict the extent of exertional oxygen desaturation in fibrotic ILD and to quantify the severity of desaturation compared to chronic obstructive pulmonary disease (COPD).

METHODS

This retrospective study compared the results of 6-min walk test (6MWT) performed while breathing room air in fibrotic ILD patients and COPD patients eligible for pulmonary rehabilitation. Outcomes included the oxygen saturation (SpO ) nadir and the change in SpO from rest during a 6MWT. Predictor variables were identified on unadjusted analysis, followed by multivariate analysis to identify independent predictors of desaturation.

RESULTS

The study included 134 patients with fibrotic ILD and 274 patients with COPD. The ILD and COPD cohorts had similar age, sex, frequency of major comorbidities, walk distance, baseline SpO and baseline Borg dyspnoea scores. DL was the strongest predictor of desaturation in both cohorts. Compared to patients with COPD, ILD patients had significantly lower SpO nadir values (88.1 ± 6.4 vs 91.0 ± 4.6) and greater decrease in SpO from baseline (7.4 ± 5.2 vs 4.5 ± 3.7) after adjusting for demographic features and pulmonary physiology (P < 0.0005), with greater between-group differences at lower DL values.

CONCLUSION

Patients with fibrotic ILD have greater oxygen desaturation during 6MWT compared to patients with COPD when adjusting for demographic features and pulmonary physiology. These findings suggest the need for disease-specific studies to evaluate the potential utility of ambulatory oxygen in fibrotic ILD.

摘要

背景与目的

尽管纤维化间质性肺疾病（ILD）的严重程度与临床和预后相关，但目前评估其运动性氧减饱和度严重程度的研究较少。本研究旨在确定可预测纤维化 ILD 患者运动性氧减饱和度严重程度的临床和生理变量，并与慢性阻塞性肺疾病（COPD）患者进行比较。

方法

本回顾性研究比较了行 6 分钟步行试验（6MWT）时接受室内空气呼吸的纤维化 ILD 患者和有资格接受肺康复的 COPD 患者的结果。主要结局指标包括氧饱和度（SpO ）最低点和 6MWT 期间 SpO 从休息时的变化。在未调整分析中确定预测变量，然后进行多变量分析以确定氧减饱和度的独立预测因子。

结果

本研究共纳入 134 例纤维化 ILD 患者和 274 例 COPD 患者。ILD 组和 COPD 组患者的年龄、性别、主要合并症频率、步行距离、基线 SpO 和基线 Borg 呼吸困难评分相似。在两个队列中，DL 是氧减饱和度的最强预测因子。在调整了人口统计学特征和肺生理学因素后，与 COPD 患者相比，ILD 患者的 SpO 最低点显著更低（88.1 ± 6.4 比 91.0 ± 4.6），SpO 从基线的下降更显著（7.4 ± 5.2 比 4.5 ± 3.7）（P < 0.0005），在较低的 DL 值时，两组之间的差异更大。