The Progression of Chronic Obstructive Pulmonary Disease Is Heterogeneous The Experience of the BODE Cohort
The Progression of Chronic Obstructive Pulmonary Disease Is Heterogeneous The Experience of the BODE Cohort
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DOI：
10.1164/rccm.201105-0831oc
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发表时间：
2011-11-01
影响因子：
24.7
通讯作者：
Celli, Bartolome R.
中科院分区：
文献类型：
--
作者：
Casanova, Ciro;de Torres, Juan P.;Celli, Bartolome R.
基本原理：慢性阻塞性肺疾病（COPD）被认为会导致肺功能的快速和进行性丧失，通常表示为整个队列的平均值。目的：需要进行纵向研究，评估个体肺功能丧失和COPD进展的其他领域。方法：我们评估了1，198例稳定的、特征良好的COPD患者，（1,100名男性）在两个中心（佛罗里达和西班牙特内里费）招募，并从1997年至2009年每年监测他们的多领域进展。患者的中位随访时间为64个月至10年。他们的个人FEV 1（L）和BODE指数斜率，表示为年度变化，使用重复测量的回归模型进行评估。总共有751例患者至少有三次测量结果用于分析。测量结果和主要结果：18%的患者有统计学显著的FEV 1斜率下降（-86 ml/yr; 95%置信区间[CI]，-32至-278 ml/yr）。较高的基线FEV 1（相对风险，1.857; 95%CI，1.322-2.610; P < 0.001）和较低的体重指数（相对风险，1.071; 95%CI，1.035-1.106; P < 0.001）与FEV 1下降独立相关。仅14%的患者BODE指数有统计学显著性增加（0.55，0.20-1.37分/年），这些患者的基线梗阻更严重。FEV 1和BODE变化之间的一致性较低（kappa Cohen，16%）。有趣的是，73%的患者FEV 1或BODE的斜率没有显著变化。只有BODE的变化与FEV 1无进展患者的死亡率相关。结论：COPD的进展是非常异质性的。大多数患者FEV 1无统计学显著下降或BODE无统计学显著增加。COPD的多维度评估应提供对COPD管理反应的见解。
Rationale: Chronic obstructive pulmonary disease (COPD) is thought to result in rapid and progressive loss of lung function usually expressed as mean values for whole cohorts.Objectives: Longitudinal studies evaluating individual lung function loss and other domains of COPD progression are needed.Methods: We evaluated 1,198 stable, well-characterized patients with COPD (1,100 males) recruited in two centers (Florida and Tenerife, Spain) and annually monitored their multidomain progression from 1997 to 2009. Patients were followed for a median of 64 months and up to 10 years. Their individual FEV1 (L) and BODE index slopes, expressed as annual change, were evaluated using regression models for repeated measures. A total of 751 patients with at least three measurements were used for the analyses.Measurements and Main Results: Eighteen percent of patients had a statistically significant FEV1 slope decline (-86 ml/yr; 95% confidence interval [CI], -32 to -278 ml/yr). Higher baseline FEV1 (relative risk, 1.857; 95% CI, 1.322-2.610; P < 0.001) and low body mass index (relative risk, 1.071; 95% CI, 1.035-1.106; P < 0.001) were independently associated with FEV1 decline. The BODE index had a statistically significant increase (0.55, 0.20-1.37 point/yr) in only 14% of patients and these had more severe baseline obstruction. Concordance between FEV1 and BODE change was low (kappa Cohen, 16%). Interestingly, 73% of patients had no significant slope change in FEV1 or BODE. Only the BODE change was associated with mortality in patients without FEV1 progression.Conclusions: The progression of COPD is very heterogeneous. Most patients show no statistically significant decline of FEV1 or increase in BODE. The multidimensional evaluation of COPD should offer insight into response to COPD management.