支气管扩张剂前后肺功能比较作为死亡率的预测指标：挪威 HUNT 研究。

Comparison of pre- and post-bronchodilator lung function as predictors of mortality: The HUNT Study.

机构信息

Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.

Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.

出版信息

Respirology. 2020 Apr;25(4):401-409. doi: 10.1111/resp.13648. Epub 2019 Jul 24.

DOI:10.1111/resp.13648

PMID:31339206

Abstract

BACKGROUND AND OBJECTIVE

Post-bronchodilator (BD) lung function is recommended for the diagnosis of chronic obstructive pulmonary disease (COPD). However, often only pre-BD lung function is used in clinical practice or epidemiological studies. We aimed to compare the discrimination ability of pre-BD and post-BD lung function to predict all-cause mortality.

METHODS

Participants aged ≥40 years with airflow limitation (n = 2538) and COPD (n = 1262) in the second survey of the Nord-Trøndelag Health Study (HUNT2, 1995-1997) were followed up until 31 December 2015. Survival analysis and time-dependent area under the receiver operating characteristic curves (AUC) were used to compare the discrimination ability of pre-BD and post-BD lung function (percent-predicted forced expiratory volume in the first second (FEV ) (ppFEV ), FEV z-score, FEV quotient (FEV Q), modified Global Initiative for Chronic Obstructive Lung Disease (GOLD) categories or GOLD grades).

RESULTS

Among 2538 participants, 1387 died. The AUC for pre-BD and post-BD ppFEV to predict mortality were 60.8 and 61.8 (P = 0.005), respectively, at 20 years' follow-up. The corresponding AUC for FEV z-score were 58.5 and 60.4 (P < 0.001), for FEV Q were 68.7 and 70.1 (P = 0.002) and for modified GOLD categories were 62.3 and 64.5 (P < 0.001). Among participants with COPD, the AUC for pre-BD and post-BD ppFEV were 57.0 and 58.8 (P < 0.001), respectively. The corresponding AUC for FEV z-score were 53.1 and 55.8 (P < 0.001), for FEV Q were 63.6 and 65.1 (P = 0.037) and for GOLD grades were 56.0 and 57.0 (P = 0.268).

CONCLUSION

Mortality was better predicted by post-BD than by pre-BD lung function; however, they differed only by a small margin. The discrimination ability using GOLD grades among COPD participants was similar.

摘要

背景和目的

支气管扩张剂后（BD）肺功能被推荐用于慢性阻塞性肺疾病（COPD）的诊断。然而，在临床实践或流行病学研究中，通常仅使用支气管扩张剂前肺功能。我们旨在比较支气管扩张剂前和后肺功能对预测全因死亡率的区分能力。

方法

参与者为年龄≥40 岁的气流受限（n=2538）和 COPD（n=1262）的诺德兰特伦德拉格健康研究（HUNT2，1995-1997）的第二次调查中的患者，随访至 2015 年 12 月 31 日。生存分析和时间依赖性接收器操作特征曲线下面积（AUC）用于比较支气管扩张剂前和后肺功能（预计第一秒用力呼气量的百分比（FEV ）（ppFEV ）、FEV z 分数、FEV 比值（FEV Q）、改良慢性阻塞性肺疾病全球倡议（GOLD）类别或 GOLD 分级）的区分能力。

结果

在 2538 名参与者中，有 1387 人死亡。20 年随访时，支气管扩张剂前和后 ppFEV 预测死亡率的 AUC 分别为 60.8 和 61.8（P=0.005）。FEV z 分数的相应 AUC 分别为 58.5 和 60.4（P<0.001），FEV Q 的 AUC 分别为 68.7 和 70.1（P=0.002），改良 GOLD 类别的 AUC 分别为 62.3 和 64.5（P<0.001）。在 COPD 患者中，支气管扩张剂前和后 ppFEV 的 AUC 分别为 57.0 和 58.8（P<0.001）。FEV z 分数的相应 AUC 分别为 53.1 和 55.8（P<0.001），FEV Q 的 AUC 分别为 63.6 和 65.1（P=0.037），GOLD 分级的 AUC 分别为 56.0 和 57.0（P=0.268）。