脉冲振荡法评估的小气道功能障碍与慢性阻塞性肺疾病患者肺功能下降及急性加重的相关性：一项中国的前瞻性队列研究

Associations of small airway dysfunction assessed by impulse oscillometry with lung function decline and exacerbations in participants with chronic obstructive pulmonary disease: A prospective cohort study in China.

作者信息

Lu Lifei, Wu Fan, Tang Gaoying, Wan Qi, Deng Zhishan, Peng Jieqi, Dai Cuiqiong, Zhou Kunning, Wu Xiaohui, Yu Shuqing, Huang Yongqing, Yang Changli, Chen Shengtang, Ran Pixin, Zhou Yumin

机构信息

Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

出版信息

Respir Med. 2025 May;241:108075. doi: 10.1016/j.rmed.2025.108075. Epub 2025 Mar 31.

DOI:10.1016/j.rmed.2025.108075

PMID:40174657

Abstract

INTRODUCTION

Small airway dysfunction (SAD) assessed by impulse oscillometry (IOS) was common in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the associations between IOS-defined small airway dysfunction (SAD) and the long-term prognosis of COPD. This study aimed to explore the associations between IOS-defined SAD, lung function decline and exacerbations in patients with COPD.

METHODS

We analyzed baseline and 2-year follow-up data from the prospective cohort study in China. We defined SAD using IOS parameters Z-score greater than the 1.645 or less than -1.645. Subsequently, these patients were divided into three groups based on the different criteria defined SAD using IOS (normal group [none IOS parameters abnormalities], inconsistent SAD [any IOS parameters abnormalities, but not all], consistent SAD [all of IOS parameters abnormalities]). Negative binomial regression was conducted to analyze the associations between SAD and exacerbations, while a multivariable linear regression model was utilized to identify associations between SAD and lung function decline.

RESULTS

833 patients with COPD were enrolled in our study. SAD (defined by X5, AX, and Fres z-score) was associated with a faster decline in lung function and higher risk of exacerbation. Meanwhile, for inconsistent diagnosis of SAD, we observed that patients with consistent SAD and inconsistent SAD experienced a faster decline in FEV and higher risk of exacerbations than those with normal group.

CONCLUSIONS

IOS-defined SAD was associated with worse outcomes in patients with COPD, and further clinical trials are needed to clarify whether early intervention to reduce the severity of small airway lesions can delay the progress of COPD.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July 2019.

摘要

引言

通过脉冲振荡法（IOS）评估的小气道功能障碍（SAD）在慢性阻塞性肺疾病（COPD）患者中很常见。然而，关于IOS定义的小气道功能障碍（SAD）与COPD长期预后之间的关联知之甚少。本研究旨在探讨IOS定义的SAD、肺功能下降和COPD患者急性加重之间的关联。

方法

我们分析了来自中国前瞻性队列研究的基线和2年随访数据。我们使用IOS参数Z值大于1.645或小于 -1.645来定义SAD。随后，根据使用IOS定义SAD的不同标准将这些患者分为三组（正常组[无IOS参数异常]、不一致SAD[任何IOS参数异常，但并非全部]、一致SAD[所有IOS参数异常]）。进行负二项回归分析SAD与急性加重之间的关联，同时使用多变量线性回归模型确定SAD与肺功能下降之间的关联。