Respiratory Function and Illness in Spinal Cord Injury

脊髓损伤（SCI）导致肌肉瘫痪，引起呼吸肌功能障碍。脊髓损伤有过早死亡的危险，呼吸系统疾病是最常见的原因。以往的脊髓损伤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，因此脊髓损伤后呼吸功能障碍的自然史在很大程度上是未知的。例如，具体未知的是，损伤后是否会比预期的衰老更快地加速功能丧失，以及除了损伤本身之外，神经水平和完整性、受伤后的时间、吸烟和喘息等因素是否是退化的独立预测因素。为了研究这一点，从1994年到1998年，我们招募了360名脊髓损伤患者的独特横断面队列，这是迄今为止进行的最大的此类研究。额外的招募和纵向随访于1999年底开始，目前资助到2002年6月。尽管通常的临床实践将脊髓损伤的呼吸功能障碍仅仅归因于神经水平和完整性，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（在标准化呼吸问卷上报告）、吸烟、以前诊断的肺部和心脏疾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全人。在这份申请中，我们建议从2002年开始，对390名SCI患者进行5年的额外研究。该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，如果修改，可能会降低慢性脊髓损伤的呼吸系统疾病发病率和死亡率。

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.