Interpreting Lung Function Data Using 80% Predicted and Fixed Thresholds Identifies Patients at Increased Risk of Mortality
Interpreting Lung Function Data Using 80% Predicted and Fixed Thresholds Identifies Patients at Increased Risk of Mortality
复制标题
DOI：
10.1378/chest.11-0797
复制
发表时间：
2012-01-01
期刊：
影响因子：
9.6
通讯作者：
Diaz-Guzman, Enrique
中科院分区：
文献类型：
--
作者：
Mannino, David M.;Diaz-Guzman, Enrique
背景资料：COPD的GOLD（慢性阻塞性肺疾病全球倡议）分期使用固定的支气管扩张剂后FEV 1/FVC比值0.70作为定义阻塞的阈值。其他人主张使用FEV 1/FVC比值、FEV 1和FVC的正常下限（LLN）来定义异常。本研究通过比较使用GOLD标准确定的异常与使用LLN标准确定的异常，调查了美国COPD成年人群的代表性样本的死亡率。方法：我们使用第三次全国健康与营养检查调查的基线数据和随访死亡率数据。我们根据GOLD与LLN标准将受试者分为阻塞性、受限性或正常性，并使用考克斯比例风险模型确定肺功能损害与死亡率之间的关系，调整协变量。结果：研究样本包括13,847例受试者，其中3,774例在随访期间死亡。在使用GOLD标准分类为阻塞和限制的受试者中，分别有20.9%和18.0%使用LLN标准分类为正常。与肺功能正常的人相比，（风险比，1.46; 95% CI，1.21-1.86）和限制性（风险比，1.94; 95% CI，1.58-2.39）使用LLN将受试者归类为正常。在具有全国代表性的第三次全国健康与营养检查调查数据中，使用LLN标准分类为正常但使用GOLD标准分类为阻塞或受限的受试者具有较高的死亡风险。胸部2012; 141（1）：73-80
Background: The GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages for COPD use a fixed ratio of the postbronchodilator FEV1/FVC ratio of 0.70 as a threshold to define obstruction. Others advocate using the lower limit of normal (LLN) for the FEV1/FVC ratio, FEV1, and FVC to define abnormality. This study investigated mortality in a representative sample of the US adult population with COPD by comparing abnormality determined using GOLD criteria to that determined using LLN criteria.Methods: We used baseline data from the Third National Health and Nutrition Examination Survey and follow-up mortality data. We classified subjects as obstructed, restricted, or normal based on GOLD vs LLN criteria and used Cox proportional hazards models to determine the relation between lung function impairment and mortality, adjusting for covariates.Results: The study sample included 13,847 subjects, of whom 3,774 died during the follow-up period. Of subjects classified as obstructed and restricted using GOLD criteria, 20.9% and 18.0%, respectively, were classified as normal using LLN criteria. Compared with people with normal lung function, mortality was increased in the obstructed (hazard ratio, 1.46; 95% CI, 1.21-1.86) and restricted (hazard ratio, 1.94; 95% CI, 1.58-2.39) subjects classified as normal using the LLN.Conclusions: In the nationally representative Third National Health and Nutrition Examination Survey data, subjects classified as normal using LLN criteria but obstructed or restricted using GOLD criteria have a higher risk of mortality. CHEST 2012; 141(1):73-80