Luis López-Campos José, Fernández-Villar Alberto, Represas Represas Cristina, Marín Barrera Lucía, Botana Rial Maribel, López Ramírez Cecilia, Casamor Ricard
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain.
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Eur Clin Respir J. 2017 Nov 2;4(1):1394132. doi: 10.1080/20018525.2017.1394132. eCollection 2017.
: COPD is a chronic disease traditionally associated with increased symptoms as lung function deteriorates. Follow-up times in previous cohort studies were limited to a few years. Interestingly, newer longer observational studies show a more comprehensive picture on disease progression over time. Therefore, the question on the relevancy of the follow-up time in cohort studies remains open. : The ON-SINT study is an observational, retrospective, nationwide, real-life cohort study, in which patients diagnosed with COPD were recruited between December 2011 and April 2013 by primary care (PC) and secondary care (SC) physicians. Patients were evaluated at the inclusion visit and at the initial visit when the diagnosis of COPD was first established. Distribution of lung function decline over the years was studied comparing those cases with longer follow-up times, with the median of the distribution as the cutoff point. : The sample included 1214 patients of which 857 (70.6%) were recruited by PC and 357 (29.4%) by SC physicians. Median follow-up time was 6.26 years. Mean annual change in the complete cohort were -4.5 (222) ml year for FVC and 5.5 (134) ml year for FEV. We confirm the variable distribution of FEV decline and found that longer follow-up periods reduce this variability. Of note, FEV decline was different between groups (shorter: 19.7 [180.4] vs longer: -9.7 [46.9]; = 0.018). Further, our data revealed differences in the clinical presentation according to follow-up times, with special emphasis on dyspnea (OR: 1.035; 95%CI: 1.014-1.056), exacerbations (OR 1.172; 95%CI 1.045-1.315) and CAT scores (OR 1.047; 95%CI 1.019-1.075) being associated with longer follow-up times. : This study describes the impact of follow-up periods on lung function variability, and reveals differences in clinical presentation according to follow-up times, with special emphasis on dyspnea, exacerbations and CAT scores.
慢性阻塞性肺疾病（COPD）是一种传统上与肺功能恶化时症状加重相关的慢性疾病。以往队列研究的随访时间限制在数年。有趣的是，更新的长期观察性研究显示了随着时间推移疾病进展的更全面情况。因此，队列研究中随访时间的相关性问题仍未解决。
ON - SINT研究是一项观察性、回顾性、全国性、真实生活队列研究，在该研究中，2011年12月至2013年4月期间，初级保健（PC）和二级保健（SC）医生招募了被诊断为COPD的患者。患者在纳入访视时以及首次确诊COPD时的初次访视时接受评估。通过比较随访时间较长的病例，以分布的中位数为分界点，研究了多年来肺功能下降的分布情况。
样本包括1214名患者，其中857名（70.6%）由初级保健医生招募，357名（29.4%）由二级保健医生招募。中位随访时间为6.26年。整个队列的平均年变化为：用力肺活量（FVC）每年-4.5（222）ml，1秒用力呼气容积（FEV）每年5.5（134）ml。我们证实了FEV下降的可变分布，并发现较长的随访期可降低这种变异性。值得注意的是，不同组之间FEV下降情况不同（较短随访期：19.7 [180.4] vs较长随访期：-9.7 [46.9]；P = 0.018）。此外，我们的数据显示根据随访时间临床表现存在差异，特别强调呼吸困难（比值比：1.035；95%置信区间：1.014 - 1.056）、急性加重（比值比1.172；95%置信区间1.045 - 1.315）和COPD评估测试（CAT）评分（比值比1.047；95%置信区间1.019 - 1.075）与较长随访时间相关。
本研究描述了随访期对肺功能变异性的影响，并揭示了根据随访时间临床表现的差异，特别强调呼吸困难、急性加重和CAT评分。
