Department of Medicine, University of California San Francisco, San Francisco, California.
Department of Surgery, University of California San Francisco, San Francisco, California.
Pediatr Pulmonol. 2020 Jun;55(6):1406-1413. doi: 10.1002/ppul.24747. Epub 2020 Apr 1.
While lung transplantation (LTx) improves health-related quality of life (HRQL) in cystic fibrosis (CF), the determinants of this improvement are unknown. In other populations, frailty-a syndrome of vulnerability to physiologic stressors-is associated with disability and poor HRQL. We hypothesized that improvements in frailty would be associated with improved disability and HRQL in adults with CF undergoing LTx.
In a single-center prospective cohort study from 2010 to 2017, assessments of frailty, disability, and HRQL were performed before and at 3- and 6-months after LTx. We assessed frailty by the short physical performance battery (SPPB). We assessed disability with the Lung Transplant Valued Life Activities scale (LT-VLA) and HRQL by the Medical Outcomes Study Short Form Physical and Mental Component Summary scales (SF12-PCS, -MCS), the Airway Questionnaire 20-Revised (AQ20R), and the Euroqol 5D (EQ5D). We tested the association of concurrent changes in frailty and lung function on disability and HRQL by linear mixed-effects models adjusted for sex and body mass index.
Among 23 participants with CF, improvements in frailty and lung function were independently associated with improved disability and some HRQL measures. For example, each 1-point improvement in SPPB or 200 mL improvement in FEV1 was associated with improved LT-VLA disability by 0.14 (95%CI: 0.08-0.20) and 0.07 (95%CI: 0.05-0.09) points and improved EQ5D by 0.05 (95%CI: 0.03 to 0.07) and 0.02 (95%CI: 0.01-0.03) points, respectively.
Improvement in frailty is a novel determinant of improved disability and HRQL in adults with CF undergoing LTx.
肺移植（LTx）可改善囊性纤维化（CF）患者的健康相关生活质量（HRQL），但其改善的决定因素尚不清楚。在其他人群中，衰弱-一种对生理应激源脆弱的综合征-与残疾和较差的 HRQL 相关。我们假设，在接受 LTx 的 CF 成人中，衰弱程度的改善与残疾和 HRQL 的改善相关。
在 2010 年至 2017 年期间进行的一项单中心前瞻性队列研究中，在 LTx 前和 3 个月及 6 个月时进行了衰弱、残疾和 HRQL 的评估。我们使用简短体能测试量表（SPPB）评估衰弱。我们使用肺移植有价值的生活活动量表（LT-VLA）评估残疾，使用医疗结局研究简明健康调查量表（SF12-PCS、-MCS）、气道问卷 20 修订版（AQ20R）和欧洲五维健康量表（EQ5D）评估 HRQL。我们通过线性混合效应模型，调整性别和体重指数后，测试了衰弱和肺功能的同时变化与残疾和 HRQL 的相关性。
在 23 名 CF 患者中，衰弱和肺功能的改善与残疾和一些 HRQL 指标的改善独立相关。例如，SPPB 每增加 1 分或 FEV1 增加 200ml，与 LT-VLA 残疾分别改善 0.14（95%CI：0.08-0.20）和 0.07（95%CI：0.05-0.09）分，与 EQ5D 分别改善 0.05（95%CI：0.03 至 0.07）和 0.02（95%CI：0.01 至 0.03）分。
在接受 LTx 的 CF 成人中，衰弱程度的改善是残疾和 HRQL 改善的一个新决定因素。
