Reply to Marruchella: Preserved Ratio Impaired Spirometry and Interstitial Lung Abnormalities in Smokers.
Reply to Marruchella: Preserved Ratio Impaired Spirometry and Interstitial Lung Abnormalities in Smokers.
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回复 Marruchella：吸烟者肺活量测定保留率受损和间质性肺异常。
DOI：
10.1164/rccm.201901-0018le
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发表时间：
2019
影响因子：
24.7
通讯作者：
Silverman,EdwinK
中科院分区：
文献类型：
--
作者：
Wan,EmilyS;Silverman,EdwinK
我怀着极大的兴趣阅读了Wan和同事们关于评估保留比率受损肺功能模式（PRISm）的论文（FEV 1/FVC> 0.7和FEV 1。80%）在他们对当前或既往吸烟者的大型队列进行的纵向研究中（1）。这种异质性疾病的患病率非常显著（基线和随访时分别为12.4%和12.5%），其与死亡率增加的相关性值得特别考虑，与慢性阻塞性肺疾病全球倡议（GOLD）2受试者中观察到的相关性相当。与GOLD 0组和GOLD 1-4组相比，PRISm患者的特征是在定量计算机断层扫描上测量的TLC%预测值和肺气肿百分比显著较低。在研究队列中，PRISm状态在5年随访时不稳定;特别是，作者报告了22%的PRISm受试者过渡到GOLD 0，约三分之一的基线GOLD 0个体过渡到PRISm。后一组的特征是在计算机断层扫描上肺气肿和空气潴留量较少，体重指数增加，基线时TLC%预测值和肺气肿百分比降低。此外，这一组表现出最大的功能下降，（FEV 1或FVC）与所有其他组相比，提示限制性生理损害。间质性肺异常已在COPD基因研究中登记的吸烟者队列中的相当少的人中发现。（慢性阻塞性肺疾病的遗传流行病学）研究（1/12），并与TLC降低和肺气肿量减少相关。间质性肺异常的吸烟者更有可能出现“未分类”的肺功能模式，类似于PRISm（2）。在此定义下，将各种形态学图片分组，这些图片可能代表静态成像结果或进行性纤维化疾病的早期阶段（3）。被鉴定为间质性肺异常携带者的吸烟者与功能上被分类为患有PRISm的吸烟者之间的许多相似性的证据使我认为，至少一小部分基线GOLD 0受试者过渡到PRISm，
I read with great interest the paper by Wan and coworkers evaluating the preserved ratio impaired spirometry (PRISm) functional pattern (FEV1/FVC> 0.7 and FEV1. 80%) in their longitudinal study of a large cohort of current or ex-smokers (1). The prevalence of this heterogeneous condition is remarkable (12.4% and 12.5% at baseline and follow-up, respectively) and its association with increased mortality, comparable to that observed in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 subjects, deserves special consideration. Individuals with PRISm are characterized by a significantly lower TLC% predicted and percent emphysema, as measured on quantitative computed tomography scans, in comparison with GOLD 0 and GOLD 1–4 groups. In the study cohort, the PRISm status was not stable at 5-year follow-up; in particular, the authors report a transition to GOLD 0 in 22% of the subjects with PRISm and a transition to PRISm in about one-third of baseline GOLD 0 individuals. The latter group was characterized by a lesser amount of emphysema and air trapping on computed tomography scans, an increase in body mass index, and decreased TLC% predicted and percent emphysema at baseline. Moreover, this group exhibited the largest functional decline (either FEV1 or FVC) in comparison with all other groups, suggesting a restrictive physiologic impairment.Interstitial lung abnormalities have been found in a substantial minority of a cohort of smokers enrolled in the COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) study (1 out of 12) and were associated with a reduced TLC and a lesser amount of emphysema. Smokers with interstitial lung abnormalities were more likely to have an “unclassified” spirometric pattern, analogous to PRISm (2). Under this definition are grouped various morphological pictures that may represent static imaging findings or the early stage of a progressive fibrosing disease (3). The evidence of many similarities between smokers identified as carriers of interstitial lung abnormalities and those functionally classified as having PRISm makes me think that at least a small subset of baseline GOLD 0 subjects who transitioned to the