高齢者における慢性閉塞性肺疾患との関連
Benjamin M Smith1,2, Miranda Kirby3, Eric A Hoffman4,5,6
1Department of Medicine, Columbia University Medical Center, New York, New York.
JAMA
|June 10, 2020
まとめ
呼吸道サイズと肺容量の不一致は,高齢者の慢性閉塞性肺疾患 (COPD) のリスク増加と関連しています. この呼吸道と肺の比率は,COPDの発症の重要な危険因子である可能性があります.
科学分野:
- 肺医学
- 放射線科
- エピデミオロジー
背景:
- 喫煙は慢性閉塞性肺疾患 (COPD) の主要な危険因子ですが,COPDのリスクの大部分は説明されていないままです.
- 喫煙以外の新たな危険因子の調査は,COPDの理解と予防に不可欠です.
研究 の 目的:
- 高齢者のCOPDの発生と関連しているかどうかを判断するために,呼吸道樹の口径と肺の大きさの不一致.
- COPDと診断された患者の肺機能低下との関連性を評価する.
主な方法:
- 多民族性動脈硬化症 (MESA) 肺研究とカナダ性阻害性肺疾患 (CanCOLD) コーホート研究からのデータを利用した遡及的なコホート研究.
- COPD研究 (SPIROMICS) のサブ集団と中間結果測定値からのケース・コントロール研究も含まれていた.
- 呼吸道と肺の比率を計算したコンピュータトモグラフィー (CT) を用いて定量化した. COPDの発生率と肺機能の低下 (FEV1:FVC比,FEV1の減少) は,既知の危険因子に調整された主要なアウトカムでした.
主要な成果:
- MESA LungとCanCOLDのコホートでは,呼吸道と肺の比率の最低四分位に属する個人は,最高四分位に属する個人に比べ,COPDの発生率を著しく高めた.
- MESA LungとCanCOLDコホートでは,呼吸道と肺機能の低下率 (FEV1減少率) との有意な関連性が見つかりませんでした.
- SPIROMICSコホートでは,呼吸道と肺の比率の最低四分位に属するCOPD患者では,MESA Lungの患者と比較して,FEV1の減少において有意な差異は見られなかったが,最高四分位に属する患者では,減少が著しく速かった.
結論:
- 肺のサイズに比べて小さな呼吸道木によって特徴づけられるディサナプシスは,高齢者の間でCOPDを発症するリスクの増加と有意に関連しています.
- この発見は,COPD発症に寄与する潜在的な危険因子であることを示唆しています.
- COPDの病原化と疾患の進行におけるその潜在的な役割を関連付けるメカニズムを探るため,さらなる研究が必要である.
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