Nishimura Koichi, Kusunose Masaaki, Shibayama Ayumi, Nakayasu Kazuhito
National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
Clinic Nishimura, Ayabe, Kyoto, Japan.
Int J Chron Obstruct Pulmon Dis. 2025 Jun 14;20:1955-1964. doi: 10.2147/COPD.S512326. eCollection 2025.
Although a cross-sectional association between frailty and chronic obstructive pulmonary disease (COPD) has been established, the longitudinal relationship between the progression of both frailty and COPD remains unclear.
This longitudinal study followed 87 COPD patients over five years, with evaluations conducted every six months. Participants underwent pulmonary function tests and completed the Kihon Checklist, a tool widely used in Japan to assess frailty. Kihon Checklist scores range from 0 (no frailty) to 25 (severe frailty), categorizing participants as robust (0-3), pre-frail (4-7), or frail (8-25). Annual changes were analyzed using linear mixed models.
A significant association was observed between time and worsening frailty classification, with patients transitioning from robust to pre-frail or from pre-frail to frail (odds ratio: 1.224, = 0.004). However, the GOLD stages (GOLD 1 to GOLD 4) did not exhibit significant progression over five years. The cohort demonstrated significant declines in forced expiratory volume in one second (FEV) and increases in Kihon Checklist total scores. FEV decreased by an estimated mean of 28.6 mL per year (95% CI: 18.9-38.4, p < 0.001), while the Kihon Checklist total score increased by 0.30 annually (95% CI: 0.09-0.51, p = 0.006). Estimated FEV declined significantly from baseline after two years in the baseline frail group (p < 0.01), after 3.5 years in the pre-frail group (p < 0.01), and after four years in the robust group (p < 0.05). Although the GOLD 3+4 group showed a significant increase in Kihon Checklist total scores after 3.5 years (p < 0.05), no significant change was observed in the GOLD 1 and GOLD 2 groups.
COPD patients with frailty show a more rapid decline in FEV, indicating accelerated COPD progression. These findings suggest frailty is static and only COPD is progressing.
尽管已确定衰弱与慢性阻塞性肺疾病（COPD）之间存在横断面关联，但衰弱和COPD进展之间的纵向关系仍不明确。
这项纵向研究对87例COPD患者进行了为期五年的随访，每六个月进行一次评估。参与者接受了肺功能测试，并完成了《基洪检查表》，这是一种在日本广泛用于评估衰弱的工具。《基洪检查表》的分数范围为0（无衰弱）至25（严重衰弱），将参与者分为强壮（0 - 3分）、衰弱前期（4 - 7分）或衰弱（8 - 25分）。使用线性混合模型分析年度变化。
观察到时间与衰弱分类恶化之间存在显著关联，患者从强壮转变为衰弱前期或从衰弱前期转变为衰弱（优势比：1.224， = 0.（此处原文可能有误，推测应为p = 0.）004）。然而，全球慢性阻塞性肺疾病倡议（GOLD）分期（GOLD 1至GOLD 4）在五年内未显示出显著进展。该队列显示一秒用力呼气容积（FEV）显著下降，且《基洪检查表》总分增加。FEV估计每年平均下降28.6 mL（95%置信区间：18.9 - 38.4，p < 0.001），而《基洪检查表》总分每年增加0.30（95%置信区间：0.09 - 0.51，p = 0.006）。在基线衰弱组中，两年后FEV从基线显著下降（p < 0.01），在衰弱前期组中，3.5年后下降（p < 0.01），在强壮组中，四年后下降（p < 0.05）。尽管GOLD 3 + 4组在3.5年后《基洪检查表》总分显著增加（p < 0.05），但GOLD 1组和GOLD 2组未观察到显著变化。
衰弱的COPD患者FEV下降更快，表明COPD进展加速。这些发现表明衰弱是静态的，只有COPD在进展。
