Izquierdo-Alonso J L, Sánchez-Hernández I, Fernández Francés J, Castelao Naval J, Carrillo Arias F, Gallardo Carrasco J
Pneumology Department, Hospital Universitario de Guadalajara, Spain.
Respiration. 1998;65(4):282-8. doi: 10.1159/000029277.
Previous studies have described that there are different types of disease in patients with established chronic obstructive pulmonary disease (COPD) with different clinical course and functional responses. The aim of this study was to evaluate if the presence of low transfer factor (LTF) values can predict the effectiveness of bronchodilator therapy, and to assess whether this group has different risk factors that may be related with the responses. Eighty patients with COPD were evaluated on three occasions. Initial assessment included a standard respiratory questionnaire, blood analysis, skin prick test and baseline lung function, all performed on the first visit. Bronchodilator response was evaluated after low (0.2 mg) and high (1 mg) doses of salbutamol, and after 2 weeks of oral prednisone. In patients with normal TLCO/VA % (NTF), a higher proportion of subjects with previous history of atopy was the only statistically significant difference compared to those with LTF (odds ratio 4.33; 95% confidence interval 1.06-25.15). Although the mean response in forced expiratory volume in 1 s (FEV1) to treatment was analogous in both groups, when bronchodilation was expressed as percent of predicted, there was a clear trend to a lower response in patients with LTF (0.2 mg salbutamol: 6.99 +/- 5.64 vs. 8.94 +/- 6. 61, p = 0.15; 1 mg salbutamol: 10.18 +/- 6.37 vs. 13.45 +/- 7.90, p < 0.05; oral prednisone: 5.51 +/- 6.94 vs. 8.74 +/- 10.81, p = 0.06). The percentage of patients who had >12% improvement from that predicted in FEV1 was also lower in this group (42 vs. 72%; p < 0. 05). Moreover, TLCO/VA% was significantly lower in those subjects with a negative bronchodilator trial with salbutamol (68 +/- 25 vs. 81 +/- 26; p < 0.05) and prednisone (69 +/- 26 vs. 90 +/- 22; p < 0. 01). In patients with LTF and NTF, airway responsiveness was only significantly related with basal airflow limitation (LTF, r = 0.44; NTF, r = 0.38). All other interaction terms were not statistically significant. These results indicate that in patiens with similar serverity of COPD, the presence of LTF indicates a decreased probability of a positive bronchodilator response, probably reflecting different pathological lesions. We suggest that transfer factor should be taken into consideration when bronchial response is evaluated in large clinical trials.
既往研究表明，已确诊的慢性阻塞性肺疾病（COPD）患者存在不同类型的疾病，其临床病程和功能反应各异。本研究的目的是评估低转运因子（LTF）值的存在是否可预测支气管扩张剂治疗的效果，并评估该组患者是否存在可能与反应相关的不同危险因素。对80例COPD患者进行了三次评估。初次评估包括标准呼吸问卷、血液分析、皮肤点刺试验和基线肺功能检查，均在首次就诊时进行。在给予低剂量（0.2mg）和高剂量（1mg）沙丁胺醇后，以及口服泼尼松2周后，评估支气管扩张剂反应。在肺一氧化碳弥散量/肺泡通气量百分比（TLCO/VA%）正常（NTF）的患者中，与LTF患者相比，有特应性病史的受试者比例较高是唯一具有统计学意义的差异（优势比4.33；95%置信区间1.06 - 25.15）。尽管两组患者1秒用力呼气容积（FEV1）对治疗的平均反应相似，但当以预测值的百分比表示支气管扩张时，LTF患者的反应有明显降低的趋势（沙丁胺醇0.2mg：6.99±5.64 vs. 8.94±6.61，p = 0.15；沙丁胺醇1mg：10.18±6.37 vs. 13.45±7.90，p < 0.05；口服泼尼松：5.51±6.94 vs. 8.74±10.81，p = 0.06）。该组中FEV1较预测值改善>12%的患者百分比也较低（42% vs. 72%；p < 0.05）。此外，沙丁胺醇支气管扩张试验阴性的受试者TLCO/VA%显著降低（68±25 vs. 81±26；p < 0.05），泼尼松试验阴性的受试者也如此（69±26 vs. 90±22；p < 0.01）。在LTF和NTF患者中，气道反应性仅与基础气流受限显著相关（LTF，r = 0.44；NTF，r = 0.38）。所有其他交互项均无统计学意义。这些结果表明，在COPD严重程度相似的患者中，LTF的存在表明支气管扩张剂反应阳性的概率降低，可能反映了不同的病理损害。我们建议在大型临床试验评估支气管反应时应考虑转运因子。
