Association between Functional Small Airway Disease and FEV1 Decline in Chronic Obstructive Pulmonary Disease
Association between Functional Small Airway Disease and FEV1 Decline in Chronic Obstructive Pulmonary Disease
复制标题
慢性阻塞性肺疾病中功能性小气道疾病与第一秒用力呼气容积下降之间的关联
DOI：
10.1164/rccm.201511-2219oc
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发表时间：
2016-07-15
影响因子：
24.7
通讯作者：
Han, MeiLan K.
中科院分区：
文献类型：
--
作者：
Bhatt, Surya P.;Soler, Xavier;Han, MeiLan K.
基本原理：小传导气道是慢性阻塞性肺疾病气流阻塞的主要部位，可能先于肺气肿的发展。Objectives：We hypothesized a novel computed tomography（CT）biomarkers of small airway disease predicted FEV 1 decline.Methods：We analyzed 1，508 current and former smokers from COPDGene with linear regression to assess predictors of change in FEV 1（ml/yr）over 5 years.使用基线临床和生理预测因子以及参数响应映射（PRM）创建的两种新型CT指标，为无气流阻塞和有气流阻塞的受试者生成单独的模型，参数响应映射（PRM）是一种将吸气和呼气CT图像配对以定义肺气肿（PRM）和功能性小气道疾病（PRMfSAD）的技术，非肺气肿空气滞留的衡量标准。测量和主要结果：GOLD的FEV 1平均（SD）下降率（毫升/年）（慢性阻塞性肺疾病全球倡议）0-4如下：41.8（47.7）、53.8（57.1）、45.6（61.1）、31.6（43.6）和5.1（35.8）（1-4级趋势检验; P < 0.001）。在多变量线性回归中，对于没有气流阻塞的参与者，PRMfSAD而不是PRMfAD与FEV 1下降相关（P < 0.001）。在GOLD 1-4参与者中，PRMfSAD和PRMfAD均与FEV 1下降相关（分别为P，0.001和P = 0.001）。基于该模型，在GOLD 1/2和3/4中，两个CT指标对FEV 1下降的比例贡献分别为87%对13%和68%对32%。CT评估的功能性小气道疾病和肺气肿与FEV 1下降相关，但与功能性小气道疾病的相关性在FEV 1下降率最大的轻中度慢性阻塞性肺疾病中最重要。
Rationale: The small conducting airways are the major site of airflow obstruction in chronic obstructive pulmonary disease and may precede emphysema development.Objectives: We hypothesized a novel computed tomography (CT) biomarker of small airway disease predicts FEV1 decline.Methods: We analyzed 1,508 current and former smokers from COPDGene with linear regression to assess predictors of change in FEV1 (ml/yr) over 5 years. Separate models for subjects without and with airflow obstruction were generated using baseline clinical and physiologic predictors in addition to two novel CT metrics created by parametric response mapping (PRM), a technique pairing inspiratory and expiratory CT images to define emphysema (PRMemph) and functional small airways disease (PRMfSAD), a measure of nonemphysematous air trapping.Measurements and Main Results: Mean (SD) rate of FEV1 decline in ml/yr for GOLD (Global Initiative for Chronic Obstructive Lung Disease) 0-4 was as follows: 41.8 (47.7), 53.8 (57.1), 45.6 (61.1), 31.6 (43.6), and 5.1 (35.8), respectively (trend test for grades 1-4; P < 0.001). In multivariable linear regression, for participants without airflow obstruction, PRMfSAD but not PRMemph was associated with FEV1 decline (P < 0.001). In GOLD 1-4 participants, both PRMfSAD and PRMemph were associated with FEV1 decline (P, 0.001 and P = 0.001, respectively). Based on the model, the proportional contribution of the two CT metrics to FEV1 decline, relative to each other, was 87% versus 13% and 68% versus 32% for PRMfSAD and PRMemph in GOLD 1/2 and 3/4, respectively.Conclusions: CT-assessed functional small airway disease and emphysema are associated with FEV1 decline, but the association with functional small airway disease has greatest importance in mild-to-moderate stage chronic obstructive pulmonary disease where the rate of FEV1 decline is the greatest.