FEV1/FVC Severity Stages for Chronic Obstructive Pulmonary Disease.
FEV1/FVC Severity Stages for Chronic Obstructive Pulmonary Disease.
复制标题
慢性阻塞性肺疾病的 FEV1/FVC 严重程度阶段。
DOI：
10.1164/rccm.202303-0450oc
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发表时间：
2023
影响因子：
24.7
通讯作者：
Bodduluri,Sandeep
中科院分区：
文献类型：
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作者：
Bhatt,SuryaP;Nakhmani,Arie;Fortis,Spyridon;Strand,MatthewJ;Silverman,EdwinK;Sciurba,FrankC;Bodduluri,Sandeep
基本原理：慢性阻塞性肺疾病 (COPD) 的诊断基于较低的 FEV1/FVC 比值，但 COPD 的严重程度是使用 FEV1% 预测 (ppFEV1) 进行分类。目标：使用 FEV1/FVC 比值测试新的 COPD 严重程度分类方案，这是比 ppFEV1 更可靠的气流阻塞测量方法。方法：在 COPDGene（COPD 遗传流行病学）中(N= 10,132)，气流阻塞的严重程度按照慢性阻塞性肺疾病全球倡议 (GOLD) 1-4 期进行分类（ppFEV1 ⩾80%、⩾50-80%、⩾30-50% 和 <30%）。在 COPDGene 中测试了新的严重程度分类（按比例对气流阻塞进行分级；STAR）——1-4 阶段的 FEV1/FVC 分别为 ⩾0.60 至 <0.70、⩾0.50 至 <0.60、⩾0.40 至 <0.50 和 <0.40，并应用于匹兹堡 SCCOR 和肺气肿 COPD 综合研究注册中心进行复制(N= 2,017)。测量和主要结果：GOLD 与新的 FEV1/FVC 比率严重程度阶段之间的一致性（加权 Bangdiwala B 值）在 COPDGene 中为 0.89，在匹兹堡队列中为 0.88。在 COPDGene 和匹兹堡队列中，与 GOLD 分期相比，STAR 分期在无气流阻塞和 1 期之间的全因死亡率、呼吸生活质量、呼吸困难、气道壁厚度、病情加重和肺功能下降方面提供了显着区分。肺气肿、小气道疾病和 6 分钟步行距离方面没有发现重大差异。 STAR 分类系统确定了更多有资格接受肺移植和肺减容手术评估的 3/4 期疾病成人。结论：新的 STAR 严重程度分类方案提供了与 GOLD 分类类似的死亡率区分，但疾病严重程度的分级更加统一。 STAR 比现有基于 ppFEV1 的方案更好地区分患者的症状、疾病负担和预后，并且对种族/民族和其他人口特征不太敏感。
Rationale:The diagnosis of chronic obstructive pulmonary disease (COPD) is based on a low FEV1/FVC ratio, but the severity of COPD is classified using FEV1% predicted (ppFEV1).Objectives:To test a new severity classification scheme for COPD using FEV1/FVC ratio, a more robust measure of airflow obstruction than ppFEV1.Methods:In COPDGene (Genetic Epidemiology of COPD) (N= 10,132), the severity of airflow obstruction was categorized by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1–4 (ppFEV1of ⩾80%, ⩾50–80%, ⩾30–50%, and <30%). A new severity classification (STaging of Airflow obstruction by Ratio; STAR) was tested in COPDGene—FEV1/FVC ⩾0.60 to <0.70, ⩾0.50 to <0.60, ⩾0.40 to <0.50, and <0.40, respectively, for stages 1–4—and applied to the combined Pittsburgh SCCOR and Emphysema COPD Research Registry for replication (N= 2,017).Measurements and Main Results:The agreements (weighted Bangdiwala B values) between GOLD and the new FEV1/FVC ratio severity stages were 0.89 in COPDGene and 0.88 in the Pittsburgh cohort. In COPDGene and the Pittsburgh cohort, compared with GOLD staging, STAR provided significant discrimination between the absence of airflow obstruction and stage 1 for all-cause mortality, respiratory quality of life, dyspnea, airway wall thickness, exacerbations, and lung function decline. No major differences were noted for emphysema, small airway disease, and 6-minute-walk distance. The STAR classification system identified a greater number of adults with stage 3/4 disease who would be eligible for lung transplantation and lung volume reduction procedure evaluations.Conclusions:The new STAR severity classification scheme provides discrimination for mortality that is similar to the GOLD classification but with a more uniform gradation of disease severity. STAR differentiates patients’ symptoms, disease burden, and prognosis better than the existing scheme based on ppFEV1, and is less sensitive to race/ethnicity and other demographic characteristics.