肺活量保持不变的烟草暴露者的表型和轨迹:肺活量的启示

Mehrdad Arjomandi, Siyang Zeng, Igor Barjaktarevic, Eugene R Bleecker, Russell P Bowler, Gerard J Criner, Alejandro P Comellas, David J Couper, Jeffrey L Curtis, Mark T Dransfield, M Bradley Drummond, Spyridon Fortis, MeiLan K Han, Nadia N Hansel, Eric A Hoffman, Robert J Kaner, Richard E Kanner, Jerry A Krishnan, Wassim Labaki, Victor E Ortega, Stephen P Peters, Stephen I Rennard, Christopher B Cooper, Donald P Tashkin, Robert Paine, Prescott G Woodruff
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引用次数: 0

摘要

背景-在慢性阻塞性肺疾病基因队列中,我们曾证实在肺活量保留的烟草暴露者(TEPS)中,不同的肺活量指数,特别是升高的总肺活量(TLC)与升高的功能残余肺活量与肺活量之比(FRC/TLC),可识别不同的肺部疾病特征。目的-确定 SPIROMICS 队列中 TEPS 的不同疾病特征以及与肺活量指数相关的轨迹。方法--我们根据基线 CT 图像得出的 TLC 或残余容积-TLC(RV/TLC)的三等分(低、中、高)对 TEPS(n=814)进行分类,然后在 TLC 高而 RV/TLC 不高([TLC]高)和 RV/TLC 高而 TLC 不高([RV/TLC]高)这两个互斥类别中检查临床和肺活量测定的疾病轨迹。我们采用回归模型研究了两类患者在基线时和随访 8.5 年期间在 CT 测量的肺气肿(HU≤-950;PRMEMPH)、气道潴留(HU≤-856;PRMfSAD;DPMGasTrap)、气道几何形状(Pi10)、呼吸系统症状(mMRC;CAT;SGRQ;SF12)和预后(年化恶化率)方面的差异。采用回归模型对年龄、性别、身高、体重、吸烟状况(目前吸烟与曾经吸烟)和吸烟负担(包年)进行了调整。结果 在 TEPS 参与者中,[TLC]高和[RV/TLC]高的肺活量疾病进展模式不同:[TLC]高的 FVC 增加,FEV1 稳定;而[RV/TLC]高的 FVC 不变,但 FEV1 名义上下降。与[TLC]高的 TEPS 相比,[RV/TLC]高的 TEPS 肺气肿较少(根据 HU≤-950),但气道疾病较多(根据 HU≤-856;PRMfSAD;DPMGasTrap 和 Pi10),呼吸道症状较多(根据 mMRC;CAT;SGRQ;SF12),基线时病情加重较严重。在平均 4.1±2.4 年(范围:0.5 至 8.5 年)的随访时间内,[RV/TLC]高的 TEPS 也更有可能出现更严重的肺活量疾病(PRISm 或 GOLD-2)和呼吸道症状恶化(通过 CAT 和 SGRQ)。虽然在随访期间,两类患者的呼吸道症状加重、住院和死亡率没有差异,但[RV/TLC]高的 TEPS 更有可能在最后一次随访时使用呼吸道吸入器。结论-在 SPIROMICS 队列的这些 TEPS 中,按 TLC 与 RV/TLC 进行肺容积分层可识别出两种具有不同呼吸道症状、影像学特征和临床轨迹的慢性阻塞性肺病前期表型。这些慢性阻塞性肺病前期表型的特征与之前 COPDGene 队列中使用 TLC 与 FRC/TLC 分层法所描述的特征一致。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Phenotypes and Trajectories of Tobacco-exposed Persons with Preserved Spirometry: Insights from Lung Volumes.

Rationale: Among tobacco-exposed persons with preserved spirometry (TEPSs), we previously demonstrated that different lung volume indices-specifically, elevated total lung capacity (TLC) versus elevated ratio of functional residual capacity to TLC (FRC/TLC)-identify different lung disease characteristics in the COPDGene cohort. Objective: We sought to determine differential disease characteristics and trajectories associated with lung volume indices among TEPSs in the SPIROMICS cohort. Methods: We categorized TEPSs (n = 814) by tertiles (low, intermediate, and high) of TLC or residual volume-to-TLC ratio (RV/TLC) derived from baseline computed tomography images and then examined clinical and spirometric disease trajectories in mutually exclusive categories of participants with high TLC without high RV/TLC ([TLC]high) versus high RV/TLC without high TLC ([RV/TLC]high). We examined differences in computed tomography-measured emphysema (Hounsfield units [HU] ⩽-950; parametric response mapping [PRM] of emphysema), air trapping (HU⩽-856; PRM of functional small airway disease; a disease probability measure for non-emphysematous gas trapping), airway geometry (the mean square root of wall area of a hypothetical airway with 10 mm internal perimeter), respiratory symptoms (on the modified Medical Research Council Dyspnea Scale; COPD Assessment Test [CAT]; St. George's Respiratory Questionnaire [SGRQ]; and Short Form-12 [SF12]), and outcomes (annualized exacerbation rate) between the two categories at baseline and over follow-up time up to 8.5 years, using regression modeling adjusted for age, sex, height, weight, and smoking status (current vs. former smoker) and burden (pack-years). Results: In TEPSs, the pattern of spirometric disease progression differed between participants with [TLC]high and those with [RV/TLC]high: There was increased forced vital capacity with stable forced expiratory volume in 1 second in participants with [TLC]high, versus unchanged forced vital capacity but nominally decreased forced expiratory volume in 1 second in those with [RV/TLC]high. Compared with participants with [TLC]high, TEPSs with [RV/TLC]high had less emphysema (by HU ⩽-950) but more airway disease (by HU ⩽-856; PRM of functional small airway disease; disease probability measure for gas trapping, and mean square root of wall area of a hypothetical airway with 10 mm internal perimeter), more respiratory symptoms (on the modified Medical Research Council Dyspnea Scale, CAT, SGRQ, and SF12), and more severe exacerbations at baseline. Over an average follow-up of 4.1 ± 2.4 years (range = 0.5-8.5 yr), TEPSs with [RV/TLC]high also had a higher likelihood of developing more severe spirometric disease (preserved ratio impaired spirometry or Global Initiative for Chronic Obstructive Lung Disease Classification 2) and worsening of their respiratory symptoms (on the CAT and SGRQ). Although the incidence rates of respiratory exacerbations, hospitalizations, and mortality were not significantly different between the two categories over the follow-up period, TEPSs with [RV/TLC]high were more likely to have been prescribed a respiratory inhaler at their last follow-up visit. Conclusions: In these TEPSs from the SPIROMICS cohort, lung volume stratification by TLC versus RV/TLC identifies two pre-COPD phenotypes with distinct respiratory symptoms, radiographic features, and clinical trajectories. The characteristics of these pre-COPD phenotypes match those previously described in the COPDGene cohort using TLC versus FRC/TLC stratification.

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