一种根据用力肺活量分类的慢性阻塞性肺疾病的特定亚型。
A specific subtype of chronic obstructive pulmonary disease classified by forced vital capacity.
作者信息
Chen Chunlan, He Ying, Chen Qiulin, Zhang Dongying, Wang Yuandi, Tang Yanling, Fang Ying, Zhong Nanshan, Jian Wenhua, Zheng Jinping
机构信息
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute for Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, China.
出版信息
J Thorac Dis. 2018 Dec;10(12):6547-6556. doi: 10.21037/jtd.2018.12.06.
BACKGROUND
Forced expiratory volume in one second (FEV) is widely used in grading the severity of the airflow limitation observed in chronic obstructive pulmonary disease (COPD). However, the characteristics of COPD classified by forced vital capacity (FVC) remain unknown. Hence, the characteristics of pulmonary function test (PFT) and clinical features of COPD patients classified by FVC were investigated.
METHODS
COPD patients were classified into three groups by FVC: (I) large consistent FVC (LC-FVC): before bronchodilator (BBD) and after bronchodilator (ABD) FVC ≥80%pred; (II) inconsistent FVC (I-FVC): BBD FVC <80%pred, while ABD FVC ≥80%pred; (III) small consistent FVC (SC-FVC): BBD and ABD FVC <80%pred. The characteristics of pulmonary function and clinical features of 1,329 retrospective patients and 403 prospective patients were analyzed in different FVC subgroups.
RESULTS
The percentages of LC-FVC, I-FVC and SC-FVC were 25.4%, 13.8% and 60.9%, respectively in the retrospective cohort, and were 34.0%, 15.6%, 50.4%, respectively in the prospective cohort. For the 1,329 retrospective patients, I-FVC showed the best responsiveness to bronchodilator when compared with those of LC-FVC and SC-FVC, no matter evaluated by FEV (0.21 0.14 0.10 L, P<0.001) or FVC (0.47 0.15 0.23 L, P<0.001), and similar results were found in the 403 prospective patients. Of the 405 retrospective patients who finished lung volume tests, I-FVC and SC-FVC demonstrated higher residual volume than that of LC-FVC (3.43 3.15 2.89 L, P<0.05), while I-FVC and LC-FVC showed higher total lung capacity than that of SC-FVC (5.92 6.06 5.18 L, P<0.05). In the prospective cohort, LC-FVC and I-FVC experienced more asthma comorbidity than that of SC-FVC (30.7% 30.2% 16.7%, P=0.005); I-FVC group tended to experience more exacerbation events than the other two groups (1.7 1.2 1.5, P=0.114).
CONCLUSIONS
COPD patients classified by BBD and ABD FVC showed obviously different clinical characteristics, which could assist in distinguishing I-FVC patients who may benefit most from bronchodilators.
背景
一秒用力呼气容积（FEV）被广泛用于评估慢性阻塞性肺疾病（COPD）气流受限的严重程度分级。然而，依据用力肺活量（FVC）对COPD进行分类的特征仍不清楚。因此，研究了按FVC分类的COPD患者的肺功能测试（PFT）特征和临床特点。
方法
根据FVC将COPD患者分为三组：（I）FVC稳定且正常（LC-FVC）：支气管扩张剂使用前（BBD）和使用后（ABD）FVC≥80%预计值；（II）FVC不稳定（I-FVC）：BBD FVC<80%预计值，而ABD FVC≥80%预计值；（III）FVC稳定且降低（SC-FVC）：BBD和ABD FVC<80%预计值。分析了1329例回顾性患者和403例前瞻性患者在不同FVC亚组中的肺功能特征和临床特点。
结果
回顾性队列中，LC-FVC、I-FVC和SC-FVC的比例分别为25.4%、13.8%和60.9%，前瞻性队列中分别为34.0%、15.6%、50.4%。对于1329例回顾性患者，无论用FEV（0.21 0.14 0.10 L，P<0.001）还是FVC（0.47 0.15 0.23 L，P<0.001）评估，I-FVC与LC-FVC和SC-FVC相比，对支气管扩张剂的反应性最佳，403例前瞻性患者中也发现了类似结果。在完成肺容积测试的405例回顾性患者中，I-FVC和SC-FVC的残气量高于LC-FVC（3.43 3.15 2.89 L，P<0.05），而I-FVC和LC-FVC的肺总量高于SC-FVC（5.92 6.06 5.18 L，P<0.05）。在前瞻性队列中，LC-FVC和I-FVC合并哮喘的比例高于SC-FVC（30.7% 30.2% 16.7%，P=0.005）；I-FVC组的急性加重事件发生率高于其他两组（1.7 1.2 1.5，P=0.114）。
结论
根据BBD和ABD FVC分类的COPD患者具有明显不同的临床特征，这有助于鉴别出可能从支气管扩张剂中获益最大的I-FVC患者。
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