Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study
Longitudinal Phenotypes and Mortality in Preserved Ratio Impaired Spirometry in the COPDGene Study
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DOI：
10.1164/rccm.201804-0663oc
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发表时间：
2018-12-01
影响因子：
24.7
通讯作者：
Silverman, Edwin K.
中科院分区：
文献类型：
--
作者：
Wan, Emily S.;Fortis, Spyridon;Silverman, Edwin K.
基本原理：随着对保留比率受损肺功能测定（PRISm）（也称为限制性或全球慢性阻塞性肺疾病倡议（GOLD）-未分类肺功能测定）的患病率和重要性的认识不断提高，扩大了关于横断面风险因素的知识体系。然而，纵向研究的PRISm仍然limited.Objectives：检查肺功能的变化，放射学特征，和死亡率的当前和以前的吸烟者与PRISm.Methods：当前和以前的吸烟者，年龄在45至80岁，入组COPDGene（第1阶段，2008-2011年）和返回的5年随访（第2阶段，2012-2016年）的纵向模式。受试者在两次研究访视时完成问卷调查、肺功能测定、胸部计算机断层扫描和6分钟步行试验。通过支气管扩张剂治疗后肺功能分类评估基线特征、肺功能纵向变化和死亡率：PRISm（FEV 1/FVC < 0.7且FEV 1 < 80%），GOLD 0（FEV 1/FVC > 0.7且FEV 1> 80%），GOLD 1 -4（FEV 1/FVC < 0.7）。测量和主要结果：尽管PRISm的患病率与（12.4-12.5%），PRISm受试者在1期和2期表现出向其他肺功能类别和从其他肺功能类别转换的显著比率。在1期PRISm受试者中，22.2%在2期时转换为GOLD 0，25.1%进展为GOLD 1 -4。与GOLD 0肺功能测定稳定的受试者相比，1期和2期PRISm受试者FEV（1）下降率降低（-27.3 -+/- 42.1 vs. -33.0 +/- 41.7 ml/年），计算机断层扫描正常的比例相当（51% vs. 52.7%）。相比之下，事件PRISm表现出肺功能下降的加速速率。受试者与PRISm在第1阶段有较高的死亡率相对于GOLD 0和较低的利率相对于GOLD 1 -4 group.Conclusions：PRISm是非常普遍的，与死亡率增加，并代表一个过渡状态的显着亚组的主题。需要进一步研究PRISm的纵向进展特征。
Rationale: Increasing awareness of the prevalence and significance of Preserved Ratio Impaired Spirometry (PRISm), alternatively known as restrictive or Global Initiative for Chronic Obstructive Lung Disease (GOLD)-unclassified spirometry, has expanded the body of knowledge on cross-sectional risk factors. However, longitudinal studies of PRISm remain limited.Objectives: To examine longitudinal patterns of change in lung function, radiographic characteristics, and mortality of current and former smokers with PRISm.Methods: Current and former smokers, aged 45 to 80 years, were enrolled in COPDGene (phase 1, 2008-2011) and returned for a 5-year follow-up (phase 2, 2012-2016). Subjects completed questionnaires, spirometry, chest computed tomography scans, and 6-minute-walk tests at both study visits. Baseline characteristics, longitudinal change in lung function, and mortality were assessed by post-bronchodilator lung function categories: PRISm (FEV1/FVC < 0.7 and FEV1 < 80%), GOLD0 (FEV1/FVC > 0.7 and FEV1 > 80%), and GOLD1-4 (FEV1/FVC < 0.7).Measurements and Main Results: Although the prevalence of PRISm was consistent (12.4-12.5%) at phases 1 and 2, subjects with PRISm exhibited substantial rates of transition to and from other lung function categories. Among subjects with PRISm at phase 1, 22.2% transitioned to GOLD0 and 25.1% progressed to GOLD1-4 at phase 2. Subjects with PRISm at both phase 1 and phase 2 had reduced rates of FEV(1 )decline (-27.3 -+/- 42.1 vs. -33.0 +/- 41.7 ml/yr) and comparable proportions of normal computed tomography scans (51% vs. 52.7%) relative to subjects with stable GOLD0 spirometry. In contrast, incident PRISm exhibited accelerated rates of lung function decline. Subjects with PRISm at phase 1 had higher mortality rates relative to GOLD0 and lower rates relative to the GOLD1-4 group.Conclusions: PRISm is highly prevalent, is associated with increased mortality, and represents a transitional state for significant subgroups of subjects. Additional studies to characterize longitudinal progression in PRISm are warranted.