Failure to Recover to Baseline Pulmonary Function after Cystic Fibrosis Pulmonary Exacerbation
Failure to Recover to Baseline Pulmonary Function after Cystic Fibrosis Pulmonary Exacerbation
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DOI：
10.1164/rccm.200909-1421oc
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发表时间：
2010-09-01
影响因子：
24.7
通讯作者：
Goss, Christopher H.
中科院分区：
文献类型：
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作者：
Sanders, Don B.;Bittner, Rachel C. L.;Goss, Christopher H.
理由：囊性纤维化患者会定期出现肺部病情恶化。先前的研究指出，一些患者的肺功能 (FEV1) 不会随着治疗而改善。 目的： 确定接受肺功能加重治疗后未恢复至肺活量基线的患者比例，并确定与未能恢复至肺活量基线相关的因素。 方法： 使用 2003-2006 年囊性纤维化基金会患者登记处进行队列研究。我们为每位患者随机选择一名接受静脉抗生素治疗的肺部病情加重患者，并将治疗后 3 个月的最佳 FEV1 与治疗前 6 个月的最佳 FEV1 进行比较。恢复至基线被定义为治疗后 3 个月内任何 FEV1 大于或等于基线 FEV1 的 90%。使用多变量逻辑回归来估计与未能恢复至基线 FEV1 的关联。测量和主要结果：在 8,479 例肺部症状加重中，25% 未能恢复至基线 FEV1。女性未能恢复到基线水平的风险较高；胰腺功能不全;营养不良；医疗补助保险；铜绿假单胞菌、洋葱伯克霍尔德菌复合体或耐甲氧西林金黄色葡萄球菌持续感染；过敏性支气管肺曲霉病;自基线肺量测定评估以来的时间较长；结论：对于随机选择的肺部急性加重患者，25%的患者在静脉注射抗生素治疗后肺功能未恢复至基线。我们确定了与未能恢复到基线相关的因素，使临床医生能够识别可能受益于更密切监测和更积极治疗的患者。
Rationale: Patients with cystic fibrosis periodically experience pulmonary exacerbations. Previous studies have noted that some patients' lung function (FEV1) does not improve with treatment.Objectives: To determine the proportion of patients treated for a pulmonary exacerbation that does not recover to spirometric baseline, and to identify factors associated with the failure to recover to spirometric baseline.Methods: Cohort study using the Cystic Fibrosis Foundation Patient Registry from 2003-2006. We randomly selected one pulmonary exacerbation treated with intravenous antibiotics per patient and compared the best FEV1 in the 3 months after treatment with the best FEV1 in the 6 months before treatment. Recovery to baseline was defined as any FEV1 in the 3 months after treatment that was greater than or equal to 90% of the baseline FEV1. Multivariable logistic regression was used to estimate associations with the failure to recover to baseline FEV1.Measurements and Main Results: Of 8,479 pulmonary exacerbations, 25% failed to recover to baseline FEV1. A higher risk of failing to recover to baseline was associated with female sex; pancreatic insufficiency; being undernourished; Medicaid insurance; persistent infection with Pseudomonas aeruginosa, Burkholderia cepacia complex, or methicillin-resistant Staphylococcus aureus; allergic bronchopulmonary aspergillosis; a longer time since baseline spirometric assessment; and a larger drop in FEV1 from baseline to treatment initiation.Conclusions: For a randomly selected pulmonary exacerbation, 25% of patients' pulmonary function did not recover to baseline after treatment with intravenous antibiotics. We identified factors associated with the failure to recover to baseline, allowing clinicians to identify patients who may benefit from closer monitoring and more aggressive treatment.