肺功能测试参考方程对系统性硬化症中限制性肺病严重程度的分类的影响
Kamini E Kuchinad1, Rachel S Wallwork1, Matthew R Lammi1
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Arthritis care & research
|September 11, 2025
概括
使用种族中立的肺功能测试 (PFTs) 可能有助于在患有全身性硬化症 (SSc) 的黑人患者中改善限制性肺病 (RLD) 严重程度的分类. 这影响了医疗保健提供和SSc-ILD的临床试验资格.
科学领域:
- 肺部医学 肺部医学
- 类风湿病学 类风湿病学
- 医学统计 医学统计
背景情况:
- 间歇性肺病 (ILD) 是系统性硬化症 (SSc) 的主要并发症,不成比例地影响黑人患者.
- 肺功能测试 (PFT) 对于诊断和监测SSc-ILD至关重要,但它们的解释可能会受到种族特定的参考方程的影响.
研究的目的:
- 调查种族特异性与种族中立性PFT参考方程对限制性肺病 (RLD) 严重程度的分类对黑人和白人SSc.患者的影响.
- 评估不同的PFT方程如何影响治疗和临床试验的资格.
主要方法:
- 计算的基线百分比预测了黑人和白人SSc患者的强迫生命能力 (ppFVC),使用种族特定 (GLI 2012,NHANES III) 和种族中立 (GLI Global) 方程.
- 在从种族特定方程转换到种族中立方程时,量化了RLD严重性类别的重新分类.
- 对比了满足免疫抑制,临床试验资格和肺移植转诊值的患者比例.
主要成果:
- 与白人相比,黑人个体的FVC绝对值较低.
- 使用种族中立 (GLI Global) 方程,47%的黑人患者被重新分类为更严重的RLD类别,而17%的白人患者被重新分类为不那么严重的类别.
- 在统计学上,更大比例的黑人患者达到治疗和试验资格的关键临床门,具有种族中立的方程.
结论:
- 种族特定的PFT参考方程可能导致对黑人SSc.患者的RLD严重程度的系统低估.
- 选择PFT参考方程显著影响医疗保健提供,临床试验资格和潜在的患者结果.
- 采用种族中立的PFT方程可以改善多样化的SSc人群获得公平的护理和研究机会.
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