Pulmonary Department, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain; Pulmonary Department, Universidad de La Laguna, Tenerife, Spain.
Pulmonary Department, Universidad de La Laguna, Tenerife, Spain.
Chest. 2021 Aug;160(2):481-490. doi: 10.1016/j.chest.2021.03.069. Epub 2021 Apr 18.
The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression.
What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?
We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time.
The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039).
Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.
ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov.
肺一氧化碳单呼吸弥散量（Dlco）对 COPD 患者的预后有价值。然而，关于 Dlco 的随时间变化的自然病程、个体间变异性以及可能影响 Dlco 进展的因素知之甚少。
COPD 患者的 Dlco 随时间的自然病程如何，哪些其他因素（包括性别差异）可能影响这种进展？
我们对 602 名吸烟者（女性占 33%）进行了表型分析，其中 506 名（84%）患有 COPD，96 名（16%）无气流受限。在 5 年内每年监测肺功能，包括 Dlco。使用随机系数模型评估 Dlco 随时间的变化。
COPD 患者的 Dlco%每年下降 1.34%±0.015%/y。与非 COPD 对照组（0.04%±0.032%/y；P=0.004）相比，这一下降速度更快。在 COPD 患者中，有 16%的患者 Dlco%斜率每年有统计学意义的下降（4.14%/y），而对照组中只有 4.3%的患者有此变化。在基线时，尽管女性的 FEV%高于男性，但患有 COPD 的女性 Dlco 值较低（11.37%±2.27%；P<0.001）。与男性相比，患有 COPD 的女性 Dlco 每年下降 0.89%±0.42%/y，更为陡峭（P=0.039）。
与无疾病的吸烟者相比，COPD 患者的 Dlco 下降更快。然而，下降速度缓慢，3 至 4 年的检测间隔可能具有临床意义。与男性相比，女性 Dlco 值较低且下降速度更快，提示性别对气体交换功能有不同的影响。
ClinicalTrials.gov；编号：NCT01122758；网址：www.clinicaltrials.gov。
