Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2025-03-01 Epub Date: 2024-10-23 DOI:10.1016/j.chest.2024.10.020

Huajing Yang, Yuqiong Yang, Fengyan Wang, Chengyu Miao, Zizheng Chen, Shanshan Zha, Xueping Li, Jiawei Chen, Aiqi Song, Rongchang Chen, Zhenyu Liang

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Abstract

Background: The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated.

Research question: Do the clinical and prognostic characteristics differ between mild-to-moderate COPD with and without emphysema?

Study design and methods: We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline low-attention lung voxels with a density < -950 Hounsfield units of < 5% on CT scans: mild-to-moderate COPD with emphysema (EC) group and mild-to-moderate COPD without emphysema (NEC) group. Linear mixed-effects models were used to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indexes between these two groups. Zero-inflated negative binomial regressions were used to evaluate the rates of acute respiratory exacerbations between the groups.

Results: Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV₁ was -56.1 mL/y for the EC group and -46.9 mL/y for the NEC group, with a nonsignificant between-group difference of 9.1 mL/y (95% CI, -24.0 to 5.7 mL/y). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (natural logarithm(%LAA_-950), -0.173%; 95% CI, -0.252% to -0.094%). The EC group also showed a more pronounced annual increase in the St. George's Respiratory Questionnaire score (0.9 points) compared with the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27-1.54).

Interpretation: The EC group did not have accelerated rates of decline in FEV₁, but they experienced significantly worse health-related quality of life and a higher rate of acute respiratory exacerbations. The nonemphysema subtype demonstrated increased emphysema progression.

Clinical trial registration: ClinicalTrials.gov; No.: NCT01969344; URL: www.

Clinicaltrials: gov.

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伴有和不伴有肺气肿的轻度至中度慢性阻塞性肺疾病的临床和预后差异。

背景：研究问题：伴有和不伴有肺气肿的轻中度慢性阻塞性肺疾病（COPD）的临床和预后特征是否存在差异？研究问题：伴有和不伴有肺气肿的轻中度慢性阻塞性肺疾病的临床和预后特征是否不同？我们从慢性阻塞性肺疾病亚人群和中期结果测量研究（SPIROMICS）中获得了989名轻度至中度慢性阻塞性肺疾病患者的临床数据。根据 CT 扫描基线 %LAA-950 低于 5%，将他们分为两组：有肺气肿组（EC 组）和无肺气肿组（NEC 组）。采用线性混合效应模型来评估这两组患者在肺功能下降、健康相关生活质量和 CT 定量指标方面的差异。采用零膨胀负二项回归评估两组间急性呼吸道症状加重率：在患有轻度至中度慢性阻塞性肺病的参与者中，有 428 人（43.3%）在 CT 扫描中显示出肺气肿。EC组的FEV1年下降率为-56.1毫升/年，NEC组为-46.9毫升/年，组间差异为9.1毫升/年（95% CI，-24.0至5.7毫升/年），差异不显著。EC组的肺气肿进展率明显低于NEC组（-0.173%；95% CI，-0.252至-0.094）。与 NEC 组相比，EC 组的 SGRQ 得分每年也有更明显的增长（0.9 分）。EC组的急性呼吸道症状加重率（每人每年0.36次）高于NEC组（每人每年0.25次），比率比为1.42（95% CI，1.27至1.54）：轻度至中度慢性阻塞性肺气肿患者的 FEV1 下降速度并不快，但他们的健康相关生活质量明显下降，急性呼吸道症状加重的发生率也较高。非肺气肿亚型患者的肺气肿进展速度加快。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.