Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow.
Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow.
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DOI：
10.1002/lary.29760
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
North American Airway Collaborative (NoAAC)
中科院分区：
文献类型：
--
作者：
Kimura K;Du L;Berry LD;Huang LC;Chen SC;Francis DO;Gelbard A;North American Airway Collaborative (NoAAC)
我们试图为特发性声门下狭窄（iSGS）患者建立规范的呼气峰流量（PEF）数据，评估手术后PEF的即时变化是否能预测长期治疗反应，并测试纵向PEF的下降是否与疾病复发有关。同意并加入北美气道协作（NoAAC） iSGS1000队列的iSGS患者在移动智能手机应用程序上记录PEF数据。Cox回归测试了术后PEF改善程度和纵向90天PEF下降与疾病复发风险之间的关系。在NoAAC iSGS1000队列中，810例患者参加了一项为期3年的前瞻性研究，比较手术治疗效果，385例患者有适当的PEF测量和随访数据。在这些患者中，42%（161/385）在研究随访期间至少需要一次手术。手术干预前平均PEF为241L/min(95%可信区间[CI]: 120-380)，预测PEF为52%。手术后PEF平均增加111 L/min （95% CI: 96-125 L/min）。有趣的是，立即PEF改善的幅度并不能预测疾病复发（100L/min增加的HR =0.90, 95%CI: 0.60-1.00）。然而，复发与90天内PEF下降幅度相关（30% vs. 10%下降，HR=2.2, 95% CI: 1.5-3.0）。我们提供了一个大型iSGS患者队列的规范PEF数据。术后PEF的改善程度与较长的无手术间隔无关。然而，90天内PEF下降30%与疾病复发风险升高相关。2级
We sought to establish normative peak expiratory flow (PEF) data for patients with idiopathic subglottic stenosis (iSGS), evaluate whether immediate changes in PEF after a procedure predict long-term treatment response, and test if a decline in longitudinal PEF is associated with disease recurrence. iSGS patients consented and enrolled in the North American Airway Collaborative (NoAAC) iSGS1000 cohort recorded PEF data on a mobile smartphone app. Cox regression tested the associations between the magnitude of postoperative PEF improvement and longitudinal 90-day PEF decline with the risk of disease recurrence. Within the NoAAC iSGS1000 cohort, 810 patients participated in a 3-year, prospective study comparing surgical treatment efficacy and 385 had appropriate PEF measurements and follow-up data. Of those patients, 42% (161/385) required at least 1 operation during study follow-up. The mean PEF preceding operative intervention was 241L/min (95% confidence interval [CI]: 120–380) corresponding to a predicted PEF of 52%. The mean increase in PEF following a procedure was 111 L/min (95% CI: 96–125 L/min). Interestingly, the magnitude of immediate PEF improvement was not predictive of disease recurrence (HR for 100L/min increase=0.90, 95%CI: 0.60–1.00). However, recurrence was associated with the magnitude of PEF decline over 90 days (30% vs. 10% decline, HR=2.2, 95% CI: 1.5–3.0). We provide normative PEF data on a large iSGS patient cohort. The degree of PEF improvement immediately after surgery was not associated with a longer procedure-free interval. However, a 30% decline in PEF over 90 days was associated with elevated risk of disease recurrence. Level 2
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通讯作者：
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