Loh Li-Cher, Ong Choo-Khoon, Koo Hyun-Jung, Lee Sang Min, Lee Jae-Seung, Oh Yeon-Mok, Seo Joon-Beom, Lee Sang-Do
Department of Medicine, RCSI & UCD Malaysia Campus, Penang, Malaysia.
Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
Int J Chron Obstruct Pulmon Dis. 2018 Aug 22;13:2543-2550. doi: 10.2147/COPD.S165898. eCollection 2018.
COPD-associated mortality was examined using a novel approach of phenotyping COPD based on computed tomography (CT)-emphysema index from quantitative CT (QCT) and post-bronchodilator (BD) forced expiratory volume in 1 second (FEV) in a local Malaysian cohort.
Prospectively collected data of 112 eligible COPD subjects (mean age, 67 years; male, 93%; mean post-BD FEV, 45.7%) was available for mortality analysis. Median follow-up time was 1,000 days (range, 60-1,400). QCT and clinicodemographic data were collected at study entry. Based on CT-emphysema index and post-BD FEV% predicted, subjects were categorized into "emphysema-dominant," "airway-dominant," "mild mixed airway-emphysema," and "severe mixed airway-emphysema" diseases.
Sixteen patients (14.2%) died of COPD-associated causes. There were 29 (25.9%) "mild mixed," 23 (20.5%) "airway-dominant," 15 (13.4%) "emphysema-dominant," and 45 (40.2%) "severe mixed" cases. "Mild mixed" disease was proportionately more in Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group A, while "severe mixed" disease was proportionately more in GOLD Groups B and D. Kaplan-Meier survival estimates showed increased mortality risk with "severe mixed" disease (log rank test, =0.03) but not with GOLD groups (=0.08). Univariate Cox proportionate hazard analysis showed that age, body mass index, long-term oxygen therapy, FEV, forced volume capacity, COPD Assessment Test score, modified Medical Research Council score, St Georges' Respiratory Questionnaire score, CT-emphysema index, and "severe mixed" disease (vs "mild mixed" disease) were associated with mortality. Multivariate Cox analysis showed that age, body mass index, and COPD Assessment Test score remain independently associated with mortality.
"Severe mixed airway-emphysema" disease may predict COPD-associated mortality. Age, body mass index, and COPD Assessment Test score remain as key mortality risk factors in our cohort.
在马来西亚当地一个队列中，采用一种基于定量CT（QCT）的CT肺气肿指数和支气管扩张剂后1秒用力呼气量（FEV）对慢性阻塞性肺疾病（COPD）进行表型分析的新方法，研究COPD相关死亡率。
前瞻性收集了112例符合条件的COPD患者的数据（平均年龄67岁；男性占93%；支气管扩张剂后平均FEV为45.7%）用于死亡率分析。中位随访时间为1000天（范围60 - 1400天）。在研究开始时收集QCT和临床人口统计学数据。根据CT肺气肿指数和支气管扩张剂后预测的FEV%，将患者分为“肺气肿为主型”、“气道为主型”、“轻度混合型气道 - 肺气肿”和“重度混合型气道 - 肺气肿”疾病。
16例患者（14.2%）死于COPD相关原因。有29例（25.9%）“轻度混合型”、23例（20.5%）“气道为主型”、15例（13.4%）“肺气肿为主型”和45例（40.2%）“重度混合型”病例。“轻度混合型”疾病在慢性阻塞性肺疾病全球倡议（GOLD）A组中所占比例相对较高，而“重度混合型”疾病在GOLD B组和D组中所占比例相对较高。Kaplan - Meier生存估计显示，“重度混合型”疾病的死亡风险增加（对数秩检验，P = 0.03），但GOLD分组与死亡风险无关（P = 0.08）。单因素Cox比例风险分析表明，年龄、体重指数、长期氧疗、FEV、用力肺活量、COPD评估测试评分、改良医学研究委员会评分、圣乔治呼吸问卷评分、CT肺气肿指数以及“重度混合型”疾病（与“轻度混合型”疾病相比）与死亡率相关。多因素Cox分析表明，年龄、体重指数和COPD评估测试评分仍然独立与死亡率相关。
“重度混合型气道 - 肺气肿”疾病可能预测COPD相关死亡率。在我们的队列中，年龄、体重指数和COPD评估测试评分仍然是关键的死亡风险因素。
