慢性阻塞性肺疾病（COPD）急性加重与有或无哮喘病史的COPD患者患肺癌的风险
Acute exacerbations of COPD and risk of lung cancer in COPD patients with and without a history of asthma.
作者信息
Gagnat Ane Aamli, Gjerdevik Miriam, Lie Stein Atle, Gulsvik Amund, Bakke Per, Nielsen Rune
机构信息
Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
出版信息
Eur Clin Respir J. 2020 Aug 7;7(1):1799540. doi: 10.1080/20018525.2020.1799540.
RATIONALE
There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma.
METHODS
In the GenKOLS study of 2003-2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function.
MEASUREMENTS AND RESULTS
During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39-5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer.
CONCLUSIONS
AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.
原理
关于慢性阻塞性肺疾病急性加重（AECOPD）对有或无哮喘病史的慢性阻塞性肺疾病（COPD）患者患肺癌风险的影响，目前了解有限。本研究旨在探讨AECOPD是否与肺癌风险相关，以及这种影响是否取决于哮喘病史。
方法
在2003 - 2005年的GenKOLS研究中，852名COPD患者进行了肺活量测定，并填写了关于吸烟习惯、症状和疾病史的问卷。这些数据与挪威癌症登记处截至2013年的肺癌数据相关联。基线时测量的AECOPD是主要预测指标。为了量化肺癌风险的差异，我们进行了Cox比例风险回归分析。我们对性别、年龄、吸烟变量、体重指数和肺功能进行了校正。
测量与结果
在随访期间，有急性加重的受试者中有8.8%被诊断为肺癌，无急性加重的受试者中有5.9%被诊断为肺癌。Cox回归分析显示，在无哮喘病史的COPD患者中，有一次或多次急性加重会显著增加患肺癌的风险，风险比（HRR）= 2.77（95%置信区间1.39 - 5.52）。我们发现哮喘病史与AECOPD在肺癌方面存在显著的交互作用。
结论
在无哮喘病史的COPD患者中，AECOPD与患肺癌风险增加相关。
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