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术前肺功能与切术后并发症的关联使用种族中立和种族特定的规范方程
Ajay Sheshadri1, Ravi Rajaram2, Aaron Baugh3
1Department of Pulmonary Medicine.
Annals of the American Thoracic Society
|October 5, 2023
概括
选择特定于种族或种族中立的肺功能测试 (PFT) 方程并不会显著改变非小细胞肺癌 (NSCLC) 患者肺功能和术后并发症之间的关联. 然而,种族中立的PFT方程揭示了并发症率的额外种族差异.
科学领域:
- 肺部医学 肺部医学
- 胸部外科手术 胸部外科手术
- 健康差距 研究 研究 研究 研究
背景情况:
- 肺功能检测 (PFT) 对于选择患者进行非小细胞肺癌 (NSCLC) 手术至关重要.
- PFT解释使用了因种族而异的规范方程,引发了关于它们对临床结果的影响的问题.
- 种族特异性与种族中立性PFT方程与肺癌手术后术后并发症的比较关联仍然不清楚.
研究的目的:
- 为了比较肺功能之间的关联的强度,使用种族中立或种族特定的规范方程进行评估,以及手术并发症.
- 评估不同PFT方程选择对预测NSCLC的分叶切除术后术后肺部并发症的影响.
主要方法:
- 在2001年至2021年期间,对3311名患者进行了回顾性研究,这些患者在2001年至2021年期间接受了为NSCLC而进行的分叶切除术,并进行了手术前PFT.
- 用全球肺功能倡议的种族特异和种族中立方程计算1秒内预测的强迫呼气量 (FEV1%) 的百分比.
- 使用后勤回归和最小绝对收缩和选择操作员 (LASSO) 分析来评估FEV1%与30天术后肺部并发症的关联,并调整并发症.
主要成果:
- 术后肺部并发症发生在31%的患者中.
- 较高的FEV1%显着与更少的并发症有关,无论是否使用种族特定或种族中立方程 (ORs ~0.98-0.99).
- 对并发症的预测模型性能 (AUC) 对于种族调整的种族中立和种族特定模型 (0.60) 都是相似的;然而,种族中立方程突出了自我认同的种族对并发症的额外影响.
结论:
- 选择种族特异或种族中立的PFT方程并不会实质性地改变NSCLC叶切除术后肺功能和肺部并发症之间的关系.
- 种族中立的PFT方程是有价值的,因为它们可以揭示手术后并发症风险中以前掩盖的种族差异.
- 进一步调查驱动这些基于种族的外科结果差异的机制是有必要的.
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