Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, One Veterans Drive, Mailstop: Pulmonary 111N, Minneapolis, MN, 55417, USA.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.
Respir Res. 2020 Aug 3;21(1):203. doi: 10.1186/s12931-020-01469-y.
Gastroesophageal reflux disease (GERD) is a common comorbidity in chronic obstructive pulmonary disease (COPD) and has been associated with increased risk of acute exacerbations, hospitalization, emergency room visits, costs, and quality-of-life impairment. However, it remains unclear whether GERD contributes to the progression of COPD as measured by lung function or computed tomography.
To determine the impact of GERD on longitudinal changes in lung function and radiographic lung disease in the COPDGene cohort.
We evaluated 5728 participants in the COPDGene cohort who completed Phase I (baseline) and Phase II (5-year follow-up) visits. GERD status was based on participant-reported physician diagnoses. We evaluated associations between GERD and annualized changes in lung function [forced expired volume in 1 s (FEV) and forced vital capacity (FVC)] and quantitative computed tomography (QCT) metrics of airway disease and emphysema using multivariable regression models. These associations were further evaluated in the setting of GERD treatment with proton-pump inhibitors (PPI) and/or histamine-receptor 2 blockers (H blockers).
GERD was reported by 2101 (36.7%) participants at either Phase I and/or Phase II. GERD was not associated with significant differences in slopes of FEV (difference of - 2.53 mL/year; 95% confidence interval (CI), - 5.43 to 0.37) or FVC (difference of - 3.05 mL/year; 95% CI, - 7.29 to 1.19), but the odds of rapid FEV decline of ≥40 mL/year was higher in those with GERD (adjusted odds ratio (OR) 1.20; 95%CI, 1.07 to 1.35). Participants with GERD had increased progression of QCT-measured air trapping (0.159%/year; 95% CI, 0.054 to 0.264), but not other QCT metrics such as airway wall area/thickness or emphysema. Among those with GERD, use of PPI and/or H blockers was associated with faster decline in FEV (difference of - 6.61 mL/year; 95% CI, - 11.9 to - 1.36) and FVC (difference of - 9.26 mL/year; 95% CI, - 17.2 to - 1.28).
GERD was associated with faster COPD disease progression as measured by rapid FEV decline and QCT-measured air trapping, but not by slopes of lung function. The magnitude of the differences was clinically small, but given the high prevalence of GERD, further investigation is warranted to understand the potential disease-modifying role of GERD in COPD pathogenesis and progression.
NCT00608764 .
胃食管反流病（GERD）是慢性阻塞性肺疾病（COPD）的常见合并症，与急性加重、住院、急诊就诊、费用和生活质量受损的风险增加有关。然而，GERD 是否会导致 COPD 的肺功能或计算机断层扫描（CT）检测到的疾病进展仍不清楚。
在 COPDGene 队列中，确定 GERD 对肺功能的纵向变化和肺部疾病的影响。
我们评估了 COPDGene 队列中的 5728 名参与者，他们完成了第 I 期（基线）和第 II 期（5 年随访）的就诊。GERD 状态基于参与者报告的医生诊断。我们使用多变量回归模型评估了 GERD 与肺功能（1 秒用力呼气量[FEV]和用力肺活量[FVC]）和定量 CT（气道疾病和肺气肿的 QCT）指标的年化变化之间的关系。在使用质子泵抑制剂（PPI）和/或组胺受体 2 阻滞剂（H 阻滞剂）治疗 GERD 的情况下，进一步评估了这些关联。
2101 名（36.7%）参与者在第 I 期和/或第 II 期报告了 GERD。FEV（差异-2.53 毫升/年；95%置信区间[CI]，-5.43 至 0.37）或 FVC（差异-3.05 毫升/年；95%CI，-7.29 至 1.19）的斜率没有显著差异，但有 GERD 的患者快速 FEV 下降≥40 毫升/年的几率更高（调整后的优势比[OR]1.20；95%CI，1.07 至 1.35）。有 GERD 的患者 QCT 测量的空气潴留进展更快（0.159%/年；95%CI，0.054 至 0.264），但其他 QCT 指标如气道壁面积/厚度或肺气肿则不然。在有 GERD 的患者中，使用 PPI 和/或 H 阻滞剂与 FEV（差异-6.61 毫升/年；95%CI，-11.9 至-1.36）和 FVC（差异-9.26 毫升/年；95%CI，-17.2 至-1.28）的更快下降有关。
GERD 与快速 FEV 下降和 QCT 测量的空气潴留所衡量的 COPD 疾病进展有关，但与肺功能的斜率无关。差异的幅度很小，但鉴于 GERD 的高患病率，有必要进一步研究以了解 GERD 在 COPD 发病机制和进展中的潜在疾病修饰作用。
NCT00608764。
