Zhang Yi, Tanabe Naoya, Sato Susumu, Shiraishi Yusuke, Maetani Tomoki, Sakamoto Ryo, Sato Atsuyasu, Muro Shigeo, Hirai Toyohiro
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Respir Physiol Neurobiol. 2024 Apr;322:104216. doi: 10.1016/j.resp.2024.104216. Epub 2024 Jan 17.
Air-trapping affects clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) and may be detected by reactance at 5 Hz (X5) on respiratory oscillometry because X5 sensitively reflects the elasticity of the chest wall, airway and lung. However, the longitudinal association between X5 and air-trapping remains to be explored. This study aimed to test whether longitudinal changes in X5 could be associated with air-trapping progression, exacerbations, and mortality in patients with COPD.
In this prospective COPD observational study, the follow-up period consisted of the first 4 years to obtain longitudinal changes in X5 and residual volume (RV) and number of exacerbations and the remaining years (year 4 to 10) to test mortality. Patients were divided into large, middle, and small X5 decline groups based on the tertiles of longitudinal change in X5, and mortality after 4 years was compared between the groups.
Patients with COPD (n = 114) were enrolled. The large X5 decline group (n = 38) showed a greater longitudinal change in RV and more exacerbations compared with the small X5 decline group (n = 39) in multivariable models adjusted for age, sex, body mass index, and smoking history. Long-term mortality after the 4-year follow-up was higher in the large X5 decline group than in the small X5 decline group (hazard ratio [95 % confidence interval] = 8.37[1.01, 69.0]) in the multivariable Cox proportional hazard model.
Longitudinal changes in respiratory reactance could be associated with progressive air-trapping, exacerbation frequency, and increased mortality in patients with COPD.
气体陷闭会影响慢性阻塞性肺疾病（COPD）患者的临床结局，并且可通过呼吸振荡法测量的5赫兹电抗（X5）检测到，因为X5能灵敏地反映胸壁、气道和肺的弹性。然而，X5与气体陷闭之间的纵向关联仍有待探索。本研究旨在检验COPD患者X5的纵向变化是否与气体陷闭进展、急性加重及死亡率相关。
在这项前瞻性COPD观察性研究中，随访期包括前4年，以获取X5和残气量（RV）的纵向变化以及急性加重次数，其余年份（第4年至第10年）用于检测死亡率。根据X5的纵向变化三分位数将患者分为X5下降大、中、小三组，并比较各组4年后的死亡率。
纳入了114例COPD患者。在根据年龄、性别、体重指数和吸烟史进行校正的多变量模型中，与X5下降小的组（n = 39）相比，X5下降大的组（n = 38）RV的纵向变化更大，急性加重次数更多。在多变量Cox比例风险模型中，X5下降大的组4年随访后的长期死亡率高于X5下降小的组（风险比[95%置信区间]= 8.37[1.01, 69.0]）。
呼吸电抗的纵向变化可能与COPD患者的进行性气体陷闭、急性加重频率及死亡率增加相关。
