Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes.
Dysanapsis is differentially related to lung function trajectories with distinct structural and functional patterns in COPD and variable risk for adverse outcomes.
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在COPD患者中，肺功能障碍与肺功能轨迹有不同的关系，具有不同的结构和功能模式，不良结局的风险也不同。
DOI：
10.1016/j.eclinm.2023.102408
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发表时间：
2024-02
影响因子：
15.1
通讯作者：
Diaz, Alejandro A.
中科院分区：
文献类型：
--
作者：
Ross, James C.;Estepar, Raul San Jose;Ash, Sam;Pistenmaa, Carrie;Han, Meilan;Bhatt, Surya P.;Bodduluri, Sandeep;Sparrow, David;Charbonnier, Jean-Paul;Washko, George R.;Diaz, Alejandro A.
关键词：
肺功能轨迹异常与慢性阻塞性肺疾病(COPD)和过早死亡的风险增加有关；已确定遵循这些轨迹的几个危险因素。气道尺寸不足呼吸紊乱(小气管腔相对于肺大小)与COPD风险增加有关。呼吸困难和COPD不良后果风险的肺功能轨迹之间的关系在很大程度上还没有被探索。我们验证了这样一个假设，即呼吸困难对不同的肺功能轨迹有不同的影响，这些轨迹与COPD的不良结局相关。为了确定肺功能轨迹，我们在COPDgene研究中对纵向FEV1和FVC Z-分数进行了贝叶斯轨迹分析，这是一项正在进行的纵向研究，收集了2007至2012年的基线数据。为了确保临床相关性，我们选择了基于全原因死亡率和COPD(ECOPD)预期加重的风险分层的轨迹。在基线COPD基因CT扫描中，以气道腔与肺体积(a/L)的比率来衡量呼吸紊乱。我们比较了轨迹之间的a/L比率，并评估了它们与轨迹分配的关联，控制了先前确定的危险因素。我们还分配了COPD基因参与者，他们最可能的轨迹只有基线数据，并重复我们的分析，以进一步评估轨迹分配与a/L比率测量之间的关系。我们确定了七个轨迹：超常轨迹、参考轨迹和五个死亡和恶化风险增加的轨迹。三个高危轨迹的特征是伴随不同程度的FEV1和FVC损害，并通过定量CT成像评估显示出以呼吸道为主的COPD模式。与参考轨迹相比，这些轨迹具有较低的a/L比值，并增加了死亡率和经社理事会的风险。两个高危轨迹的特征是FEV1和FVC受损程度不同，在定量CT成像上显示混合气道和肺气肿COPD模式。与参考轨迹和以呼吸道为主的轨迹相比，这些轨迹的a/L比值明显较低，并且与以气道为主的轨迹相比，死亡率和ECOPD的风险更大。这些发现也是在只有基线数据的参与者中观察到的。呼吸紊乱的程度似乎预示着导致慢性阻塞性肺疾病的进展模式。在临床环境中，将个体--包括那些没有肺活量障碍的个体--分配到不同的轨迹是可能的，并可能影响管理策略。将CT评估的呼吸困难与肺功能的肺活量测量和烟雾暴露评估相结合的策略可能会进一步提高轨迹分配的准确性，从而改善对那些有不良后果风险最高的人的早期发现。美国、和。
Abnormal lung function trajectories are associated with increased risk of chronic obstructive pulmonary disease (COPD) and premature mortality; several risk factors for following these trajectories have been identified. Airway under-sizing dysanapsis (small airway lumens relative to lung size), is associated with an increased risk for COPD. The relationship between dysanapsis and lung function trajectories at risk for adverse outcomes of COPD is largely unexplored. We test the hypothesis that dysanapsis differentially affects distinct lung function trajectories associated with adverse outcomes of COPD. To identify lung function trajectories, we applied Bayesian trajectory analysis to longitudinal FEV1 and FVC Z-scores in the COPDGene Study, an ongoing longitudinal study that collected baseline data from 2007 to 2012. To ensure clinical relevance, we selected trajectories based on risk stratification for all-cause mortality and prospective exacerbations of COPD (ECOPD). Dysanapsis was measured in baseline COPDGene CT scans as the airway lumen-to-lung volume (a/l) ratio. We compared a/l ratios between trajectories and evaluated their association with trajectory assignment, controlling for previously identified risk factors. We also assigned COPDGene participants for whom only baseline data is available to their most likely trajectory and repeated our analysis to further evaluate the relationship between trajectory assignment and a/l ratio measures. We identified seven trajectories: supranormal, reference, and five trajectories at increased risk for mortality and exacerbations. Three at-risk trajectories are characterized by varying degrees of concomitant FEV1 and FVC impairments and exhibit airway predominant COPD patterns as assessed by quantitative CT imaging. These trajectories have lower a/l ratio values and increased risk for mortality and ECOPD compared to the reference trajectory. Two at-risk trajectories are characterized by disparate levels of FEV1 and FVC impairment and exhibit mixed airway and emphysema COPD patterns on quantitative CT imaging. These trajectories have markedly lower a/l ratio values compared to both the reference trajectory and airway-predominant trajectories and are at greater risk for mortality and ECOPD compared to the airway-predominant trajectories. These findings were observed among the participants with baseline-only data as well. The degree of dysanapsis appears to portend patterns of progression leading to COPD. Assignment of individuals—including those without spirometric obstruction—to distinct trajectories is possible in a clinical setting and may influence management strategies. Strategies that combine CT-assessed dysanapsis together with spirometric measures of lung function and smoke exposure assessment are likely to further improve trajectory assignment accuracy, thereby improving early detection of those most at risk for adverse outcomes. United States , , and .
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DOI：
10.1183/09031936.00080312
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作者：
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影响因子：
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DOI：
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DOI：
10.1164/rccm.201707-1405oc
发表时间：
2018-10-15
影响因子：
24.7
作者：
Ross, James C.;Castaldi, Peter J.;Estepar, Raul San Jose
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