老年人患有慢性阻塞性肺部疾病
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
概括
呼吸道大小与肺体积不匹配,与老年人慢性阻塞性肺病 (COPD) 的风险增加有关. 这种呼吸道/肺部比率可能是发展COPD的重要风险因素.
科学领域:
- 肺部医学
- 放射学
- 流行病学
背景情况:
- 吸烟是慢性阻塞性肺病 (COPD) 的主要风险因素,但COPD风险的很大一部分仍未得到解释.
- 研究除了吸烟之外的新风险因素对于了解和预防COPD至关重要.
研究的目的:
- 确定呼吸道树口径与肺部大小之间的不匹配是否与老年人中慢性肺炎的发病率有关.
- 在被诊断为COPD的个体中,评估dysanapsis与肺功能下降的关联.
主要方法:
- 一项回顾性队列研究,利用多民族动脉样硬化 (MESA) 肺研究和加拿大阻塞性肺病队列 (CanCOLD) 的数据.
- 还包括了COPD研究中的子群体和中间结果测量 (SPIROMICS) 的病例对照研究.
- 使用计算机断层扫描 (CT) 量化了dysanapsis,计算了气道到肺的比率. 经已知风险因素调整后,COPD发病率和肺功能下降 (FEV1:FVC比率和FEV1下降) 是主要结果.
主要成果:
- 在MESA肺部和CanCOLD群体中,与最高四分位数相比,呼吸道与肺部比率最低四分位数的个体呈现出明显更高的COPD发病率.
- 在MESA肺和CanCOLD队列中,呼吸道与肺功能下降率 (FEV1下降率) 之间没有发现显著的关联.
- 在SPIROMICS队列中,与MESA肺部参与者相比,COPD患者的FEV1下降率没有显著差异,而最高四分位数的患者的下降速度明显更快.
结论:
- 与肺部大小相对较小的气道树特征,与老年人患COPD的风险显著增加有关.
- 这些发现表明,dysanapsis是导致COPD发展的潜在危险因素.
- 需要进行进一步的研究,以探索与COPD病变相关联的机制及其在疾病进展中的潜在作用.
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