State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & Guangzhou Institute of Respiratory Health & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
Guangzhou National Laboratory, Guangzhou, Guangdong, China.
BMJ Open Respir Res. 2024 Jul 20;11(1):e002320. doi: 10.1136/bmjresp-2024-002320.
Impaired ventilatory efficiency during exercise is a predictor of mortality in chronic obstructive pulmonary disease. However, little is known about the clinical features and associated factors of impaired ventilatory efficiency in China.
We conducted a cross-sectional community-based study in China and collected demographic and clinical information, cardiopulmonary exercise testing, spirometry, and CT data. Impaired ventilatory efficiency was defined by a nadir ventilatory equivalent for CO production above the upper limit of normal. Multivariable linear and logistic regression models were used to explore the clinical features and associated factors of impaired ventilatory efficiency.
The final analyses included 941 subjects, 702 (74.6%) of whom had normal ventilatory efficiency and 239 (25.4%) had impaired ventilatory efficiency. Participants with impaired ventilatory efficiency had more chronic respiratory symptoms, poorer lung function and exercise capacity, and more severe emphysema (natural logarithm transformation of the low-attenuation area of the lung with attenuation values below -950 Hounsfield units, logLAA: 0.19±0.65 vs -0.28±0.63, p<0.001) and air trapping (logLAA: 1.03±0.65 vs 0.68±0.70, p<0.001) than those with normal ventilatory efficiency. Older age (60-69 years, OR 3.10 (95% CI 1.33 to 7.21), p=0.009 and 70-80 years, OR 6.48 (95% CI 2.56 to 16.43), p<0.001 vs 40-49 years) and smoking (former, OR 3.19 (95% CI 1.29 to 7.86), p=0.012; current, OR 4.27 (95% CI 1.78 to 10.24), p=0.001 vs never) were identified as high risk factors of impaired ventilatory efficiency.
Impaired ventilatory efficiency was associated with poorer respiratory characteristics. Longitudinal studies are warranted to explore the progression of individuals with impaired ventilatory efficiency.
在慢性阻塞性肺疾病患者中，运动时通气效率受损是死亡的预测指标。然而，对于中国人群中通气效率受损的临床特征及其相关因素，我们知之甚少。
我们在中国进行了一项横断面社区研究，收集了人口统计学和临床信息、心肺运动试验、肺量计检查和 CT 数据。通过二氧化碳产生的最小通气当量高于正常值上限来定义通气效率受损。采用多元线性和逻辑回归模型来探讨通气效率受损的临床特征及其相关因素。
最终分析纳入了 941 名受试者，其中 702 名（74.6%）通气效率正常，239 名（25.4%）通气效率受损。通气效率受损者有更多的慢性呼吸系统症状、更差的肺功能和运动能力，以及更严重的肺气肿（肺低衰减区的自然对数转换值，衰减值低于-950 豪斯菲尔德单位，logLAA：0.19±0.65 比-0.28±0.63，p<0.001）和空气潴留（logLAA：1.03±0.65 比 0.68±0.70，p<0.001）。与通气效率正常者相比，年龄较大（60-69 岁，OR 3.10（95%CI 1.33 至 7.21），p=0.009；70-80 岁，OR 6.48（95%CI 2.56 至 16.43），p<0.001 比 40-49 岁）和吸烟（既往，OR 3.19（95%CI 1.29 至 7.86），p=0.012；当前，OR 4.27（95%CI 1.78 至 10.24），p=0.001 比从不）是通气效率受损的高风险因素。
通气效率受损与较差的呼吸特征相关。需要进行纵向研究来探索通气效率受损个体的进展情况。
