Tracey M, Villar A, Dow L, Coggon D, Lampe F C, Holgate S T
University Medicine Southampton University, United Kingdom.
Am J Respir Crit Care Med. 1995 Mar;151(3 Pt 1):656-62. doi: 10.1164/ajrccm/151.3_Pt_1.656.
We have performed a 4-yr prospective survey of the association of allergen skin test positivity, total serum immunoglobulin E (IgE), and bronchial responsiveness to methacholine, with longitudinal decline in FEV1, in subjects over 65 yr of age. In 1987, 324 subjects completed a respiratory questionnaire, and underwent measurement of FEV1 and FVC, methacholine challenge, skin prick testing (to Dermatophagoides pteronyssinus, cat fur, mixed grasses, and Aspergillus fumigatus) and estimation of total serum IgE. After an interval of 4 yr, 212 subjects were reexamined. The mean annual decline in FEV1 was significantly higher in males than in females, but was not significantly influenced by smoking habits defined at the start of the study. The relation of atopy (skin test reaction to allergen > or = 3 mm greater than saline control), increased bronchial responsiveness (PD20FEV1 < or = 6.4 mumoles methacholine) and serum IgE > 80 IU/ml, to annual decline in FEV1 was examined for each risk factor individually with adjustment for age, sex, height, and initial FEV1, by multiple linear regression. Both atopy and bronchial responsiveness were significantly associated with accelerated decline in FEV1. Elevated IgE was correlated with faster FEV1 decline in subjects who were current smokers at the start of the study. In a multiple regression model examining the mutually adjusted associations of all relevant variables with annual decline in FEV1, male sex was the most important predictor (B = 38.6 ml/yr, 95% Cl = 4.3, 72.9). Increased bronchial responsiveness also tended to be associated with accelerated decline in FEV1. In further analyses incorporating the same variables, but restricted to specific smoking categories, age was the only significant factor in the never-smokers, whereas both atopy (B = 44.5 ml/yr, 95% Cl = 3.8, 85.3) and increased bronchial responsiveness (B = 43.5 ml/yr, 95% Cl = 4.6, 82.3) were significant predictors of accelerated FEV1 decline in former and current smokers combined.(ABSTRACT TRUNCATED AT 250 WORDS)
我们对65岁以上受试者进行了一项为期4年的前瞻性调查，研究过敏原皮肤试验阳性、血清总免疫球蛋白E（IgE）以及支气管对乙酰甲胆碱的反应性与第一秒用力呼气容积（FEV1）的纵向下降之间的关联。1987年，324名受试者完成了一份呼吸问卷，并接受了FEV1和用力肺活量（FVC）测量、乙酰甲胆碱激发试验、皮肤点刺试验（针对粉尘螨、猫毛、混合草和烟曲霉）以及血清总IgE的测定。间隔4年后，对212名受试者进行了复查。男性FEV1的年平均下降幅度显著高于女性，但不受研究开始时所定义的吸烟习惯的显著影响。通过多元线性回归，在对年龄、性别、身高和初始FEV1进行校正后，分别对每个危险因素（特应性，即皮肤试验对过敏原的反应比生理盐水对照大≥3mm；支气管反应性增加，即FEV1的20%下降剂量（PD20FEV1）≤6.4微摩尔乙酰甲胆碱；血清IgE>80IU/ml）与FEV1年下降之间的关系进行了研究。特应性和支气管反应性均与FEV1加速下降显著相关。在研究开始时为当前吸烟者的受试者中，IgE升高与FEV1下降更快相关。在一个多元回归模型中，研究了所有相关变量与FEV1年下降的相互校正关联，男性性别是最重要的预测因素（B = 38.6ml/年，95%可信区间 = 4.3，72.9）。支气管反应性增加也往往与FEV1加速下降相关。在纳入相同变量但仅限于特定吸烟类别的进一步分析中，年龄是从不吸烟者中唯一的显著因素，而在既往吸烟者和当前吸烟者合并组中，特应性（B = 44.5ml/年，95%可信区间 = 3.8，85.3）和支气管反应性增加（B = 43.5ml/年，95%可信区间 = 4.6，82.3）均是FEV1加速下降的显著预测因素。（摘要截断于250字）
