Pulmonary arterial enlargement and acute exacerbations of COPD.
Pulmonary arterial enlargement and acute exacerbations of COPD.
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DOI：
10.1056/nejmoa1203830
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发表时间：
2012-09-06
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影响因子：
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通讯作者：
ECLIPSE Study Investigators
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作者：
Wells JM;Washko GR;Han MK;Abbas N;Nath H;Mamary AJ;Regan E;Bailey WC;Martinez FJ;Westfall E;Beaty TH;Curran-Everett D;Curtis JL;Hokanson JE;Lynch DA;Make BJ;Crapo JD;Silverman EK;Bowler RP;Dransfield MT;COPDGene Investigators;ECLIPSE Study Investigators
慢性阻塞性肺疾病（COPD）的恶化与肺功能的加速丧失和死亡有关。识别有这些事件风险的患者，特别是需要住院治疗的患者，是非常重要的。重度肺动脉高压是晚期COPD的重要并发症，可预测急性加重，尽管肺血管异常也会在病程早期发生。我们假设肺血管疾病的计算机断层扫描（CT）指标（肺动脉扩张，由肺动脉直径与主动脉直径的比值决定[PA: a比值]为bbbb1）与严重的COPD加重有关。我们进行了一项多中心观察性试验，招募了目前和以前患有COPD的吸烟者。我们确定了PA: a比值大于1与入组时需要住院治疗的严重恶化史之间的关联，然后在该队列的纵向随访以及外部验证队列中检查了该比值作为这些事件预测因子的有用性。我们使用了逻辑回归和零膨胀负二项回归分析，并调整了已知的恶化危险因素。多变量logistic回归分析显示，PA: a比值大于1与入组时的严重恶化史之间存在显著关联（优势比为4.78；95%可信区间[CI]， 3.43 ~ 6.65； P<0.001）。在试验队列（优势比，3.44;95% CI, 2.78 ~ 4.25； P<0.001）和外部验证队列（优势比，2.80;95% CI, 2.11 ~ 3.71； P<0.001）中，比值大于1也与未来严重恶化的风险增加独立相关。在两个队列中，在分析的所有变量中，PA: a比值大于1与严重恶化的相关性最强。CT检测肺动脉扩张（a PA: a比值为>.1）与COPD严重加重有关。（由国家心脏、肺和血液研究所资助；ClinicalTrials.gov号码：NCT00608764和NCT00292552。）
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P<0.001). A PA:A ratio of more than 1 was also independently associated with an increased risk of future severe exacerbations in both the trial cohort (odds ratio, 3.44; 95% CI, 2.78 to 4.25; P<0.001) and the external validation cohort (odds ratio, 2.80; 95% CI, 2.11 to 3.71; P<0.001). In both cohorts, among all the variables analyzed, a PA:A ratio of more than 1 had the strongest association with severe exacerbations. Pulmonary artery enlargement (a PA:A ratio of >1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.)