Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease
Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease
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DOI：
10.1136/thx.2006.062026
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发表时间：
2007-02-01
期刊：
影响因子：
10
通讯作者：
Polkey, Michael I.
中科院分区：
文献类型：
--
作者：
Swallow, Elisabeth B.;Reyes, Diana;Polkey, Michael I.
背景资料：气流阻塞指数对慢性阻塞性肺疾病（COPD）预后的预测性较差，因为反映疾病全身性质的其他因素也影响预后。目的：检验股四头肌最大随意收缩力（QMVC）降低是COPD患者死亡率有用预测因子的假设。向184例COPD患者的初级保健医生发送死亡率调查问卷，这些患者在过去5年中接受了股四头肌力量测量。QMVC表示为患者体重指数的百分比。测量的终点是死亡或肺移植，中位（范围）随访时间为38（1 - 54）months.Results：数据获得了162例患者（108名男性和54名女性）的平均（SD）百分比用力呼气容积1秒（FEV 1）预测值为35.6（16.2），反应率为88%。该队列的1年无移植生存率为93.5%，2年为87.1%。考克斯回归模型显示，死亡风险随着年龄的增加和QMVC的减少而增加。只有年龄（HR 1.72（95% CI 1.14至2.6）; p = 0.01）和QMVC（HR 0.91（95%CI 0.83至0.99）; p = 0.036）在多变量分析中控制其他变量时，仍然是死亡率的重要预测因素。与年龄、体重指数和1 s用力呼气容积相比，QMVC简单易行，可提供更有力的COPD预后信息。
Background: Prognosis in chronic obstructive pulmonary disease ( COPD) is poorly predicted by indices of air flow obstruction, because other factors that reflect the systemic nature of the disease also influence prognosis.Objective: To test the hypothesis that a reduction in quadriceps maximal voluntary contraction force ( QMVC) is a useful predictor of mortality in patients with COPD.Methods: A mortality questionnaire was sent to the primary care physician of 184 patients with COPD who had undergone quadriceps strength measurement over the past 5 years. QMVC was expressed as a percentage of the patient's body mass index. The end point measured was death or lung transplantation, and median ( range) follow- up was 38 ( 1 - 54) months.Results: Data were obtained for 162 patients ( 108 men and 54 women) with a mean ( SD) percentage of forced expiratory volume in 1 s ( FEV1) predicted of 35.6 ( 16.2), giving a response rate of 88%. Transplantfree survival of the cohort was 93.5% at 1 year and 87.1% at 2 years. Cox regression models showed that the mortality risk increased with increasing age and with reducing QMVC. Only age ( HR 1.72 ( 95% CI 1.14 to 2.6); p = 0.01) and QMVC ( HR 0.91 ( 95% CI 0.83 to 0.99); p = 0.036) continued to be significant predictors of mortality when controlled for other variables in the multivariate analysis.Conclusion: QMVC is simple and provides more powerful prognostic information on COPD than that provided by age, body mass index and forced expiratory volume in 1 s.