Ghazala Zena, Pertzborn Matthew, Feimster Macey, Akmyradov Chary, Mack Joana, Saccente Suzanne, Berlinski Ariel
Department of Pediatrics, Pediatric Pulmonary Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Department of Pediatrics, University of Tennessee Health Science Center, Memphis, USA.
Pediatr Blood Cancer. 2025 Aug;72(8):e31825. doi: 10.1002/pbc.31825. Epub 2025 May 27.
Lung disease is a major cause of morbidity and mortality in children with sickle cell disease (SCD), a condition that is more common in individuals of African American descent. Spirometry is utilized in monitoring lung health. Recently, the American Thoracic Society recommended the use of race-neutral predictive equations. We aimed to evaluate how the use of race-neutral equations may affect spirometry results and interpretation in children with SCD.
This retrospective study included children aged 5-21 years with SCD followed at Arkansas Children's Hospital (01/01/2000-06/30/2023) who had completed at least one spirometry. Percent predictive (pp) and z-score values were calculated using race-adjusted and race-neutral predictive equations. Absolute and relative differences were calculated. Percent of subjects with forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC) with z-score <-1.645 and pp < 80%, and FEV/FVC z-score < -1.645 were compared. Severity of impairment based on z-score was compared.
One hundred children completed 460 spirometries. Transitioning from race-adjusted to race-neutral equations resulted in [mean (SD)]: a decrease in ppFEV [-9.497% (2.8344)], FEV z-score [-0.723 (0.2286)], ppFVC [-10.08% (3.3440)], FVC z-score [-0.750 (0.2757)], FEV/FVC z-score [-0.057 (0.05461)], and an increase in ppFEV/FVC [0.2785 (0.3921)]. Transitioning from race-adjusted to race-neutral equations resulted in an increase of impairment for FVC and FEV and a threefold increase in subjects with abnormal values.
Adoption of race-neutral reference equations resulted in a decrease in FEV and FVC values (z-scores and percent predicted) and an increase in severity of impairment.
肺部疾病是镰状细胞病（SCD）患儿发病和死亡的主要原因，这种疾病在非裔美国人后裔中更为常见。肺功能测定用于监测肺部健康。最近，美国胸科学会建议使用不考虑种族的预测方程。我们旨在评估使用不考虑种族的方程如何影响SCD患儿的肺功能测定结果及解读。
这项回顾性研究纳入了在阿肯色儿童医院（2000年1月1日至2023年6月30日）接受随访的5至21岁SCD患儿，这些患儿至少完成了一次肺功能测定。使用种族调整和不考虑种族的预测方程计算预测百分比（pp）和z评分值。计算绝对差异和相对差异。比较一秒用力呼气容积（FEV）和用力肺活量（FVC）的z评分<-1.645且pp<80%，以及FEV/FVC的z评分<-1.645的受试者百分比。比较基于z评分的损伤严重程度。
100名儿童完成了460次肺功能测定。从种族调整方程转换为不考虑种族的方程导致[均值（标准差）]：ppFEV降低[-9.497%（2.8344）]，FEV的z评分[-0.723（0.2286）]，ppFVC降低[-10.08%（3.3440）]，FVC的z评分[-0.750（0.2757）]，FEV/FVC的z评分[-0.057（0.05461）]，以及ppFEV/FVC升高[0.2785（0.3921）]。从种族调整方程转换为不考虑种族的方程导致FVC和FEV的损伤增加，异常值受试者增加了两倍。
采用不考虑种族的参考方程导致FEV和FVC值（z评分和预测百分比）降低，损伤严重程度增加。
