Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team
Should We View Chronic Obstructive Pulmonary Disease Differently after ECLIPSE? A Clinical Perspective from the Study Team
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DOI：
10.1164/rccm.201311-2006pp
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发表时间：
2014-05-01
影响因子：
24.7
通讯作者：
Tal-Singer, Ruth
中科院分区：
文献类型：
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作者：
Vestbo, Jorgen;Agusti, Alvar;Tal-Singer, Ruth
基本原理：慢性阻塞性肺疾病（COPD）似乎是一种异质性疾病，具有可变的course.Objectives：我们希望纵向描述COPD的异质性和可变性。在对2,164例临床稳定的COPD患者、337例肺功能正常的吸烟者和245例从不吸烟者进行的COPD纵向评价以确定预测性替代终点（ECLIPSE）研究中，我们通过计算机断层扫描测量了大量的临床参数、肺功能、运动耐量、生物标志物和肺气肿的量。所有这三个组进行了3 years. Measures和主要结果：我们发现一个显着的异质性COPD患者之间，与FEV 1，症状，生活质量，功能结果，和生物标志物之间的相关性较差。全身性炎症仅见于有限比例的患者，与基线特征或疾病进展无关，但增加了预测死亡率的预后价值。随着时间的推移对急性加重进行跟踪，并将其添加到“频繁加重表型”的概念中。“病程变化很大，近三分之一的患者根本没有进展。评估了FEV 1和肺密度3年变化的风险因素。对于FEV 1下降，持续吸烟和肺气肿的存在是进展的最强预测因子; dub细胞蛋白被发现是疾病活动的潜在生物标志物。对于肺气肿的进展，最强的预测因素是继续吸烟和female sex.Conclusions：通过随访一个大型的、特征良好的COPD患者队列超过3年，我们对具有临床重要亚型（“表型”）的异质性疾病和可变的、非固有的进展过程有了更清晰的了解。
Rationale: Chronic obstructive pulmonary disease (COPD) seems to be a heterogeneous disease with a variable course.Objectives: We wished to characterize the heterogeneity and variability of COPD longitudinally.Methods: In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study of 2,164 patients with clinically stable COPD, 337 smokers with normal lung function, and 245 never-smokers, we measured a large number of clinical parameters, lung function, exercise tolerance, biomarkers, and amount of emphysema by computed tomography. All three groups were followed for 3 years.Measurements and Main Results: We found a striking heterogeneity among patients with COPD, with poor correlations between FEV1, symptoms, quality of life, functional outcomes, and biomarkers. Presence of systemic inflammation was found in only a limited proportion of patients, and did not relate to baseline characteristics or disease progression, but added prognostic value for predicting mortality. Exacerbations tracked over time and added to the concept of the "frequent exacerbator phenotype." Disease course was very variable, with close to a third of patients not progressing at all. Risk factors for 3-year change in both FEV1 and lung density were assessed. For FEV1 decline, continued smoking and presence of emphysema were the strongest predictors of progression; dub cell protein was found to be a potential biomarker for disease activity. For progression of emphysema, the strongest predictors were continued smoking and female sex.Conclusions: By following a large, well characterized cohort of patients with COPD over 3 years, we have a clearer picture of a heterogeneous disease with clinically important subtypes ("phenotypes") and a variable and not inherently progressive course.