Forced Expiratory Volume in 1 Second Variability Helps Identify Patients with Cystic Fibrosis at Risk of Greater Loss of Lung Function
Forced Expiratory Volume in 1 Second Variability Helps Identify Patients with Cystic Fibrosis at Risk of Greater Loss of Lung Function
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DOI：
10.1016/j.jpeds.2015.08.042
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发表时间：
2016-02-01
影响因子：
5.1
通讯作者：
Konstan, Michael W.
中科院分区：
文献类型：
--
作者：
Morgan, Wayne J.;VanDevanter, Donald R.;Konstan, Michael W.
目的评价囊性纤维化患者1秒预期用力呼气量（FEV1 %pred）变异性作为未来FEV1 %pred下降的潜在预测因子的几种替代测量方法。研究设计我们纳入了13827例年龄b> = 6岁的囊性纤维化流行病学研究（1994 - 2002）患者，在2年的基线期和2年的随访期中，>= 4 FEV1 %的pred测量跨越>= 366天。我们通过使用4个肺部疾病分期分层的多变量回归来预测从最佳基线FEV1 %pred到最佳随访FEV1 %pred的变化，以及从基线到最佳随访第二年的变化。我们评估了5种变异性指标（一些作为与最佳值的偏差，一些作为与趋势线的偏差），单独评估和控制了人口统计学和临床因素以及FEV1 %pred的斜率和水平后评估。结果5项FEV1 %pred变异性均可预测，但最强预测因子是基线期最佳FEV1 %pred的中位数偏差。对解释能力（R-2）的贡献是巨大的，超过了除FEV1 %的预期下降率外所有其他因素的总贡献。添加其他可变性度量提供了最小的附加价值。结论与最佳FEV1 %pred的中位数偏差是一个简单的指标，即使在纳入人口统计学和临床特征以及FEV1 %pred下降率后，也能显著提高FEV1 %pred下降的预测。这种变异性测量的常规计算可以让临床医生更好地识别有风险的患者，因此需要增加干预。
Objective To evaluate several alternative measures of forced expiratory volume in 1 second percent predicted (FEV1 %pred) variability as potential predictors of future FEV1 %pred decline in patients with cystic fibrosis.Study design We included 13 827 patients age >= 6 years from the Epidemiologic Study of Cystic Fibrosis 19942002 with >= 4 FEV1 %pred measurements spanning >= 366 days in both a 2-year baseline period and a 2-year followup period. We predicted change from best baseline FEV1 %pred to best follow-up FEV1 %pred and change from baseline to best in the second follow-up year by using multivariable regression stratified by 4 lung-disease stages. We assessed 5 measures of variability (some as deviations from the best and some as deviations from the trend line) both alone and after controlling for demographic and clinical factors and for the slope and level of FEV1 %pred.Results All 5 measures of FEV1 %pred variability were predictive, but the strongest predictor was median deviation from the best FEV1 %pred in the baseline period. The contribution to explanatory power (R-2) was substantial and exceeded the total contribution of all other factors excluding the FEV1 %pred rate of decline. Adding the other variability measures provided minimal additional value.Conclusions Median deviation from the best FEV1 %pred is a simple metric that markedly improves prediction of FEV1 %pred decline even after the inclusion of demographic and clinical characteristics and the FEV1 %pred rate of decline. The routine calculation of this variability measure could allow clinicians to better identify patients at risk and therefore in need of increased intervention.