在没有近期恶化病史的个人中,慢性阻塞性肺病恶化的危险因素:COPD基因分析
Michael C Ferrera1, Camden L Lopez2, Susan Murray2
1Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Annals of the American Thoracic Society
|October 5, 2023
概括
确定未来COPD恶化的危险因素至关重要. 胃食道逆流性疾病,慢性支气管炎,高症状负担和肺功能减弱预测慢性阻塞性肺病 (COPD) 患者没有最近恶化史的恶化.
科学领域:
- 肺部医学 肺部医学
- 流行病学 流行病学
- 临床研究 临床研究
背景情况:
- 慢性阻塞性肺病 (AE-COPD) 的急性恶化显著影响疾病的进展.
- 在没有近期恶化病史的患者中,未来AE-COPD的预测因素仍然不完全理解.
研究的目的:
- 在COPD研究遗传流行病学 (COPDGene) 队列中,在前一年没有恶化病史的个人中确定COPD恶化的风险因素.
- 开发一个简单的,临床上适用的风险评分来预测未来的恶化.
主要方法:
- 从COPDGene研究中分析了1528名患有COPD和吸烟史的参与者,不包括在第二次访问前一年出现恶化的人.
- 利用单变量和多变量零膨胀负二项式回归来识别风险因素.
- 通过结合已识别的风险因素的回归系数,开发了一个渐进式风险评分.
主要成果:
- 在36个月的时间里,33.2%的参与者至少经历过一次中度或重度恶化.
- 确定的危险因素包括胃食道逆流性疾病,慢性支气管炎,高症状负担 (使用mMRC和CAT得分) 和预测的较低FEV1%.
- 渐进风险得分每增加1个点,就与恶化率增加25-30%相关.
结论:
- 在没有最近恶化的COPD患者中,诸如GERD,慢性支气管炎,症状负担和肺功能减弱等特定因素与未来恶化的风险增加有关.
- 简单的,分级风险评分,包括这些因素,可以帮助临床实践预测AE-COPD.
- 进一步的研究可以完善风险分层,以积极管理COPD恶化.
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