Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Center for Respiratory Diseases, JCHO Hokkaido Hospital, Sapporo, Japan.
Sci Rep. 2019 Feb 14;9(1):2073. doi: 10.1038/s41598-019-38659-8.
Long-term decline in lung function is generally considered to be progressive in individuals with established chronic obstructive pulmonary disease (COPD), despite the presence of intersubject variation. We hypothesized that the annualized rate of decline in forced expiratory volume in 1 second (FEV) would not be constant among different time periods in the natural history of established COPD. We compared the annual change rates in FEV during the first 5 years and the last 5 years, estimated separately using a linear mixed-effects model in 10-year survivors (n = 110). The subjects were classified into three FEV decline groups, based on the 25th and 75th percentile values in each time period. The rates of FEV changes, calculated from the first 5 years and the last 5 years, did not correlate with each other among 10-year survivors; the subjects of each FEV decline group during the first 5 years did not consistently remain in the same FEV decline group during the last 5 years. Smoking status and exacerbation frequency were not associated with decline in FEV. In conclusion, the disease activity, which is often expressed as annualized change in FEV, might be changeable either way over years in patients with established COPD.
长期以来，人们普遍认为，在已经确诊的慢性阻塞性肺疾病（COPD）患者中，肺功能下降是渐进的，尽管存在个体间的差异。我们假设，在已确诊 COPD 的自然史的不同时间段中，第 1 秒用力呼气量（FEV）的年下降率不会保持不变。我们使用线性混合效应模型，对 10 年幸存者（n=110）分别在最初 5 年和最后 5 年的 FEV 年变化率进行了比较。根据每个时间段的第 25 和 75 百分位值，将受试者分为三个 FEV 下降组。在 10 年幸存者中，从最初 5 年和最后 5 年计算得出的 FEV 变化率彼此之间没有相关性；最初 5 年每个 FEV 下降组的受试者在最后 5 年期间并不始终保持在相同的 FEV 下降组。吸烟状况和加重频率与 FEV 下降无关。总之，在已经确诊的 COPD 患者中，疾病活动度（通常以 FEV 的年变化率来表示）可能在几年内以任意方式发生变化。
