Markers of disease severity in chronic obstructive pulmonary disease
Markers of disease severity in chronic obstructive pulmonary disease
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DOI：
10.1016/j.pupt.2005.05.001
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Della Pasqua, OE
中科院分区：
文献类型：
--
作者：
Franciosi, LG;Page, CP;Della Pasqua, OE
背景和目标：慢性阻塞性肺疾病（COPD）的诊断和治疗效果评估主要依赖于对一组复杂症状的检查和肺功能测定法的使用。然而，这些方法需要长时间的评估，以确定患者在干预后是否表现出临床相关的改善。因此，我们希望确定现有的临床和实验室指标如何随着COPD严重程度的变化，并确定疾病标志物，可以作为更好的诊断和评估COPD进展和治疗效果的终点。方法：使用标准的COPD关键词和术语，我们搜索PubMed，ISI Web of Science和科克伦回顾数据库自1966年以来发表的回顾性和前瞻性临床研究。我们根据肺量测定和人口统计学数据的可用性、可能标志物的调查、无急性加重和合并症以及停用标准COPD药物，确定了1978年至2003年9月的652项研究（n= 146，255）。根据研究样本量、吸烟状态和轻度、中度和重度COPD分期，收集受试者基线测量的集中趋势和离散度。一个固定效应的荟萃分析，然后进行每个措施，在不同的疾病stages.Results：动脉血氧分压，痰中性粒细胞和IL-8，血清TNF-α和C-反应蛋白显示出一种趋势，对COPD阶段之间的分离。其他措施，如包年和圣乔治的呼吸问卷只区分疾病和无病state.Conclusions：我们观察到疾病阶段之间的许多措施用于CON）诊断和临床试验的分离。这表明这些终点对定义患者的临床状态和量化治疗效果的敏感性较差。因此，我们建议将纵向研究和疾病建模作为评估疾病进展的潜在标志物是否可用于COPD诊断和临床试验的主要方法。(c)2005爱思唯尔有限公司保留所有权利。
Background and objectives: Diagnosis and assessment of treatment effect in chronic obstructive pulmonary disease (COPD) have relied primarily on the examination of a complex set of symptoms and the use of spirometry. However, these methods require long periods of assessment to determine whether patients show clinically relevant improvements after intervention. We therefore wanted to determine how existing clinical and laboratory measures change with COPD severity and identify disease markers that can serve as better endpoints for diagnosis and assessment of COPD progression and treatment effect.Methods: Using standard COPD keywords and terms, we searched PubMed, ISI Web of Science, and Cochrane Review databases for retrospective and prospective clinical studies published since 1966. We identified 652 studies (n= 146,255) from 1978 to September 2003 based on the availability of spirometric and demographic data, investigation of possible markers, absence of acute exacerbations and comorbidities, and the withdrawal of standard COPD medication. Central tendencies and dispersions of subject baseline measures were collected according to study sample size, smoking status, and mild, moderate and severe COPD stages. A fixed effect meta-analysis was then conducted on each measure at various disease stages.Results: Arterial oxygen tension, Sputum neutrophils and IL-8, and serum TNF-alpha and C-Reactive Protein showed a trend toward separation between COPD stages. Other measures such as pack-years and St George's Respiratory Questionnaire only distinguished between disease and disease-free states.Conclusions: We observed little separation between disease stages for many measures used in CON) diagnosis and clinical trials. This demonstrates the poor sensitivity of such endpoints to define a patient's clinical status and to quantity treatment effect. Therefore, we recommend that longitudinal studies and disease modelling be the primary methods for assessing whether potential markers of disease progression can be used for COPD diagnosis and clinical trials. (c) 2005 Elsevier Ltd. All rights reserved.