Emphysema and extrapulmonary tissue loss in COPD: a multi-organ loss of tissue phenotype
Emphysema and extrapulmonary tissue loss in COPD: a multi-organ loss of tissue phenotype
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DOI：
10.1183/13993003.02146-2017
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发表时间：
2018-02-01
影响因子：
24.3
通讯作者：
Agusti, Alvar
中科院分区：
文献类型：
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作者：
Celli, Bartolome R.;Locantore, Nicholas;Agusti, Alvar
我们在来自ECLIPSE慢性阻塞性肺疾病（COPD）队列的1817例患者中检测了肺气肿进展是否伴随其他身体部位的组织丢失增强，比较了根据定量断层扫描肺气肿四分位数分组的受试者的临床和选定的全身生物标志物测量值，使用低衰减面积百分比（LAA%）。最低和最高四分位数的患者具有氨基酸代谢组学特征。我们将LAA%与3年内肺功能下降（1秒用力呼气容积（FEV 1））、体重指数（BMI）、去脂体重指数（FFMI）、急性加重、住院和死亡率相关，基线肺气肿越多的参与者FEV 1、BMI和FFMI越低，功能能力越差，心血管疾病越少，但骨质疏松症越多。全身C-反应蛋白和白细胞介素-6水平组间相似，但俱乐部细胞蛋白16较高，白细胞介素-8，表面活性蛋白D和晚期糖基化终产物可溶性受体较低，肺气肿更多。代谢组学在极端肺气肿四分位数之间存在差异。肺气肿患者FEV 1、BMI和FFMI下降速度加快，加重、住院和死亡率增加，肺气肿患者肺组织和肺外组织丢失过多，可能与组织维持异常有关。由于更差的临床结果，我们建议将该亚组命名为多器官组织损失（MOLT）COPD表型。
We tested whether emphysema progression accompanies enhanced tissue loss in other body compartments in 1817 patients from the ECLIPSE chronic obstructive pulmonary disease (COPD) cohort.Clinical and selected systemic biomarker measurements were compared in subjects grouped by quantitative tomography scan emphysema quartiles using the percentage of low attenuation area (LAA%). Lowest and highest quartile patients had amino-acid metabolomic profiles. We related LAA% to 3 years decline in lung function (forced expiratory volume in 1 s (FEV1)), body mass index (BMI), fat-free mass index (FFMI) and exacerbations, hospitalisations and mortality rates.Participants with more baseline emphysema had lower FEV1, BMI and FFMI, worse functional capacity, and less cardiovascular disease but more osteoporosis. Systemic C-reactive protein and interleukin-6 levels were similar among groups, but club cell protein 16 was higher and interleukin-8, surfactant protein D and soluble receptor for advanced glycation end product were lower with more emphysema. Metabolomics differed between extreme emphysema quartiles. Patients with more emphysema had accelerated FEV1, BMI and FFMI decline and more exacerbations, hospitalisations and mortality.COPD patients with more emphysema undergo excessive loss of pulmonary and extrapulmonary tissue, which is probably related to abnormal tissue maintenance. Because of worse clinical outcomes, we propose this subgroup be named the multi-organ loss of tissue (MOLT) COPD phenotype.