Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España.
Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España.
PLoS One. 2018 Jun 28;13(6):e0198777. doi: 10.1371/journal.pone.0198777. eCollection 2018.
Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing.
EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics.
A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05).
Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.
α-1 抗胰蛋白酶缺乏症（AATD）是成年人中最常见的遗传性疾病，但未得到充分认识。在西班牙，根据流行病学研究，诊断为 AATD 的患者数量远低于预期。本研究的目的是评估 COPD 患者检测血清α1-抗胰蛋白酶（AAT）水平的频率和决定因素，并描述与检测相关的因素。
EPOCONSUL 是一项横断面临床审计，在一年时间内连续招募 COPD 患者。本研究评估了 COPD 患者检测血清 AAT 水平的情况，并评估了个体、疾病相关和医院特征之间的关系。
共评估了来自西班牙 57 家医院的 4405 例 COPD 患者的临床记录。只有 995（22.5%）例患者在某些情况下检测了血清 AAT。一些患者特征（男性[OR 0.5，p<0.001]、≤55 岁[OR 2.38，p<0.001]、BMI≤21kg/m2[OR 1.71，p<0.001]、FEV1（%）<50%[OR 1.35，p<0.001]、慢性支气管炎[OR 0.79，p<0.001]、Charlson 指数≥3[OR 0.66，p<0.001]或哮喘病史或症状[OR 1.32，p<0.001]）以及在 COPD 专科门诊就诊[OR 2.73，p<0.001]被确定为与 COPD 患者进行 AATD 检测相关的独立因素。总体而言，114 例（占检测患者的 11.5%）COPD 患者存在 AATD。其中，26 例（22.8%）患者存在严重缺乏。AATD 患者更年轻，吸烟指数较低，更有可能患有肺气肿（p<0.05）。
在西班牙门诊呼吸科治疗的 COPD 患者中，检测 AAT 血液水平的情况并不常见。然而，当进行检测时，五分之一的 COPD 患者会检测到 AATD（基于血清 AAT 水平≤100mg/dL）。需要努力优化 COPD 中 AATD 的病例检出率。
