Respiratory Function and Illness in Spinal Cord Injury

脊髓损伤(SCI)导致肌肉瘫痪，导致呼吸肌功能障碍。在脊髓损伤中，存在过早死亡的风险，呼吸系统疾病是最常见的原因。先前关于脊髓损伤的横断面研究存在设计和方法上的缺陷，而且由于从未进行过纵向评估，脊髓损伤后呼吸功能障碍的自然病史在很大程度上是未知的。例如，具体未知的是损伤后是否存在比预期更严重的衰老功能加速丧失，以及除损伤本身外，神经水平和完整性、自受伤以来的时间、吸烟和喘息等因素是否是恶化的独立预测因素。为了研究这一点，从1994年到1998年，我们招募了360名脊髓损伤受试者的独特横断面队列，这是迄今为止进行的最大规模的此类研究。这批人员的额外征聘和纵向后续行动于1999年底开始，目前供资至2002年6月。虽然将脊髓损伤的呼吸功能障碍仅仅归因于神经系统水平和完整性是常见的临床实践，但我们的横断面分析表明，胸部疾病和肺功能障碍也与一些因素独立相关，其中一些因素比损伤本身更重要。这些因素包括喘息(在标准化呼吸问卷中报告)、吸烟、以前诊断的肺病和心脏病，以及呼吸肌力量受损。初步的纵向分析表明，持续吸烟对脊髓损伤患者肺功能的影响大于健康人。在这份申请中，我们建议从2002年开始，对390名SCI受试者进行额外5年的研究。这项研究将评估这些因素和其他因素在肺功能纵向变化和胸部疾病发生中的重要性，并将确定潜在的可修改因素，如果进行修改，可能会降低慢性脊髓损伤中呼吸系统疾病的发病率和死亡率。

Spinal cord injury (SCI) results in muscle paralysis causing respiratory muscle dysfunction. In SCI, there is risk for premature death, and diseases of the respiratory system are the most common cause. Previous cross-sectional studies in SCI have design and methodological flaws and, since there has never been a longitudinal assessment, the natural history of respiratory dysfunction following SCI is largely unknown. Specifically unknown, for example, are whether after injury there is an accelerated loss of function greater than expected for aging and whether, other than the injury itself, factors such as neurological level and completeness, time since injury, smoking, and wheeze are independent predictors of deterioration. To study this, from 1994-1998, we recruited a unique cross-sectional cohort of 360 subjects with SCI, the largest such study conducted to date. Additional recruitment and longitudinal follow-up of this cohort began in late 1999 and is currently funded through 6/2002. Although it is common clinical practice to attribute respiratory dysfunction in SCI solely to neurological level and completeness, our cross-sectional analyses suggest that chest illness and pulmonary dysfunction are also related independently to factors some of which are more important than the injury per se. These factors include wheeze (as reported on a standardized respiratory questionnaire), cigarette smoking, previously diagnosed lung and heart disease, and impairment of respiratory muscle strength. Preliminary longitudinal analyses suggest that the effect of continued smoking on pulmonary function is greater in SCI than in the able-bodied. In this application, we propose an additional 5 years of study, starting in 2002, of 390 subjects with SCI. The study will assess the importance of these and other factors in the longitudinal change in pulmonary function and occurrence of chest illness, and will identify potentially modifiable factors that, if modified, may reduce respiratory disease morbidity and mortality in chronic SCI.