Copenhagen City Heart Study, Frederiksberg-Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Biochemistry and.
Am J Respir Crit Care Med. 2020 Jul 15;202(2):210-218. doi: 10.1164/rccm.201911-2115OC.
Chronic obstructive pulmonary disease (COPD) can develop not only through a lung function trajectory dominated by an accelerated decline of FEV from normal maximally attained FEV in early adulthood (normal maximally attained FEV trajectory) but also through a trajectory with FEV below normal in early adulthood (low maximally attained FEV trajectory). To test whether the long-term risk of exacerbations and mortality differs between these two subtypes of COPD. The cohort included 1,170 young adults enrolled in the Copenhagen City Heart Study during the 1970s and 1980s. In 2001-2003, which served as the baseline for the present analyses, 79 participants had developed COPD through normal maximally attained FEV trajectory, 65 had developed COPD through low maximally attained FEV trajectory, and 1,026 did not have COPD. From 2001 until 2018, we observed 139 severe exacerbations of COPD and 215 deaths, of which 55 were due to nonmalignant respiratory disease. In Cox models, there was no difference with regard to risk of severe exacerbations between the two trajectories, but individuals with normal maximally attained FEV had an increased risk of nonmalignant respiratory disease mortality (using inverse probability of censoring weighting with adjusted hazard ratio [HR], 6.20; 95% confidence interval [CI], 2.09-18.37; = 0.001) and all-cause mortality (adjusted HR, 1.93; 95% CI, 1.14-3.26; = 0.01) compared with individuals with low maximally attained FEV. COPD developed through normal maximally attained FEV trajectory is associated with an increased risk of respiratory and all-cause mortality compared with COPD developed through low maximally attained FEV trajectory.
慢性阻塞性肺疾病（COPD）不仅可以通过在成年早期快速下降至最大预计值（FEV）的轨迹（正常最大预计值 FEV 轨迹）发展，也可以通过在成年早期 FEV 低于正常的轨迹（低最大预计值 FEV 轨迹）发展。为了检验这两种 COPD 亚型的长期恶化和死亡风险是否存在差异。该队列纳入了 1970 年代至 1980 年代期间参加哥本哈根城市心脏研究的 1170 名年轻人。2001-2003 年作为本分析的基线，79 名参与者通过正常最大预计值 FEV 轨迹发展为 COPD，65 名参与者通过低最大预计值 FEV 轨迹发展为 COPD，1026 名参与者未发展为 COPD。从 2001 年到 2018 年，我们观察到 139 例 COPD 严重恶化和 215 例死亡，其中 55 例是由非恶性呼吸疾病导致的。在 Cox 模型中，两种轨迹之间的严重恶化风险没有差异，但正常最大预计值 FEV 的个体发生非恶性呼吸疾病死亡的风险增加（使用逆概率于删失加权的调整后的危险比 [HR]，6.20；95%置信区间 [CI]，2.09-18.37； = 0.001）和全因死亡率（调整后的 HR，1.93；95% CI，1.14-3.26； = 0.01），与低最大预计值 FEV 的个体相比。与低最大预计值 FEV 发展为 COPD 相比，通过正常最大预计值 FEV 发展为 COPD 与呼吸和全因死亡风险增加相关。
