Alter Peter, Rabe Klaus F, Schulz Holger, Vogelmeier Claus F, Jörres Rudolf A
Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany,
LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany.
Int J Chron Obstruct Pulmon Dis. 2018 Aug 23;13:2551-2555. doi: 10.2147/COPD.S164096. eCollection 2018.
For interpretation of body plethysmographic static hyperinflation, reference values are of crucial importance. Earliest reference values have been published by the European Coal and Steel Community (ECSC) and are based on sex, body height and age as predictors. As obesity can lead to a reduction of functional residual capacity (FRC) in lung-healthy subjects, more recent approaches included body weight or body surface area. This raises the question whether these models are appropriate in patients with COPD-induced hyperinflation.
Several FRC prediction models and their relation to body weight were analyzed in 1513 patients with stable COPD (mean [SD] age: 64.5 [8.2] years; GOLD grades 1-4: 219/722/484/88), a subset of the multicenter COPD and Systemic Consequences - Comorbidities Network cohort.
Absolute values of FRC were inversely related to body mass index (<0.001). Applying the ECSC equations to calculate predicted values, this pattern was maintained (<0.001). By contrast, an inverted, ie, positive, relation occurred when using equations that include body weight or surface area (<0.001). The present analysis confirmed the inverse relation of body mass and FRC in COPD, resulting from a restrictive ventilatory pattern by diaphragm elevation and decreased chest wall compliance in obesity. The weight influence in the prediction models, as obtained from lung-healthy controls, appears to lead to an overcorrection and consequently to an inappropriate overestimation of hyperinflation as indicated by FRC %predicted in COPD.
It is concluded that models not including body weight as predictor, like the classical ECSC equations, could be superior in the interpretation of FRC in COPD.
对于人体体积描记法静态肺过度充气的解读，参考值至关重要。最早的参考值由欧洲煤钢共同体（ECSC）发布，基于性别、身高和年龄作为预测指标。由于肥胖会导致肺部健康受试者的功能残气量（FRC）降低，最近的方法纳入了体重或体表面积。这就引发了一个问题，即这些模型对于慢性阻塞性肺疾病（COPD）所致肺过度充气的患者是否适用。
在多中心COPD及其全身后果 - 合并症网络队列的一个子集中，对1513例稳定期COPD患者（平均[标准差]年龄：64.5 [8.2]岁；GOLD分级1 - 4级：219/722/484/88）分析了几种FRC预测模型及其与体重的关系。
FRC的绝对值与体重指数呈负相关（<0.001）。应用ECSC方程计算预测值时，这种模式得以维持（<0.001）。相比之下，使用包含体重或体表面积的方程时，出现了相反的，即正相关关系（<0.001）。本分析证实了COPD患者体重与FRC之间的负相关关系，这是由肥胖时膈肌抬高导致的限制性通气模式和胸壁顺应性降低所致。从肺部健康对照者获得的预测模型中的体重影响，似乎导致了过度校正，从而导致对COPD中FRC预测百分比所表明的肺过度充气的不适当高估。
得出的结论是，像经典的ECSC方程那样不将体重作为预测指标的模型，在解读COPD患者的FRC时可能更具优势。
