Respiratory medicine最新文献_第6页

A novel respiratory reactance index, frequency-dependent, and for effort-independent assessment of COPD severity using MostGraph 一种新的呼吸阻抗指数，依赖于频率，并使用MostGraph来评估COPD的严重程度。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-15 DOI: 10.1016/j.rmed.2026.108656

Hiroyuki Tsuji , Sho Mitsuya , Kenjiro Tsuruoka , Takahiko Nakamura , Yosuke Tamura , Isao Goto , KyongYob Min , Soichiro Ikeda , Akihisa Imagawa , Yasuhito Fujisaka

Background

Oscillometry has gained attention as a respiratory function test that does not require patient effort, particularly in older individuals and in those with severe respiratory disease. Although spirometry is essential for classifying the severity of chronic obstructive pulmonary disease (COPD), it requires forced expiration, which may be difficult in frail patients. In COPD, the slope of the respiratory reactance curve measured by oscillometry changes. This study evaluated the usefulness of a novel index, [X5 × (Fres−5)]/ALX, which quantifies the frequency dependence of respiratory reactance using parameters measurable by oscillometry.

Methods

This retrospective observational study included patients with COPD who underwent spirometry and oscillometry at Osaka Medical and Pharmaceutical University Hospital between March 2014 and January 2020. X5, Fres, and ALX were measured using the MostGraph to calculate the novel index. Receiver operating characteristic (ROC) analysis was performed to assess diagnostic performance for detecting Global Initiative for Obstructive Lung Disease (GOLD) stage 3/4 COPD, including sex-specific evaluations.

Results

Based on chest CT findings, patients with lung cancer or interstitial lung disease were excluded, leaving 109 participants. The novel index demonstrated strong performance in identifying GOLD stage 3/4 COPD (AUC: 0.858; sensitivity: 81.0 %; specificity: 79.5 %), outperforming X5, Fres, and ALX individually. The AUCs were 0.874 in males and 0.914 in females. The index showed a moderate correlation with %FEV1 (r_s = 0.603).

Conclusion

The index [X5 × (Fres−5)]/ALX effectively reflects the frequency dependence of respiratory reactance and may serve as a useful, effort-independent tool for assessing COPD severity, particularly for identifying GOLD stage 3/4 disease.

背景：振荡测量法作为一种不需要患者努力的呼吸功能测试已经引起了人们的关注，特别是在老年人和患有严重呼吸系统疾病的患者中。虽然肺活量测定法对慢性阻塞性肺疾病（COPD）的严重程度进行分类是必不可少的，但它需要强制呼气，这在虚弱的患者中可能很困难。在慢性阻塞性肺病中，振荡法测量的呼吸电抗曲线斜率发生变化。本研究评估了一种新的指数[x5x (fre -5)]/ALX的有效性，该指数使用振荡法测量的参数量化呼吸电抗的频率依赖性。方法：这项回顾性观察性研究纳入了2014年3月至2020年1月在大阪医科大学医院接受肺活量测定和振荡测量的COPD患者。使用MostGraph测量X5、Fres和ALX以计算新指数。进行受试者工作特征（ROC）分析，以评估全球阻塞性肺疾病倡议（GOLD） 3/4期COPD的诊断性能，包括性别特异性评估。结果：根据胸部CT表现，排除肺癌或间质性肺疾病患者，留下109名参与者。该新指标在识别GOLD期3/4期COPD方面表现出色（AUC: 0.858，敏感性：81.0%，特异性：79.5%），优于X5、Fres和ALX。男性的auc为0.874，女性为0.914。该指数与%FEV1呈中等相关性（r_s = 0.603）。结论：指数[x5x (fre -5)]/ALX能有效反映呼吸阻抗的频率依赖性，可作为评估COPD严重程度的有用且不依赖于努力的工具，特别是用于识别GOLD 3/4期疾病。

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引用次数: 0

Old criteria, new intelligence: The evolution of ECG in pulmonary hypertension diagnosis 旧标准，新智能：心电图在肺动脉高压诊断中的演变

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.rmed.2026.108646

Nancy Herrera-Leaño , Sandeep Sahay , Raymond L. Benza , Julian Barahona-Correa , Francois Haddad

Background

Pulmonary hypertension (PH) carries a significant mortality risk, highlighting the need for improved early detection strategies. This review examines the evolution of electrocardiographic assessment in PH diagnosis, from traditional criteria to artificial intelligence (AI) algorithms.

Methods

We conducted a literature review analyzing 24 studies published between 1986 and 2025, including 18 traditional ECG validation studies and 6 AI-based investigations. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and QUADAS-AI frameworks. Studies were categorized by approach and diagnostic performance metrics were systematically evaluated.

Results

Traditional ECG criteria demonstrated consistently high specificity (71–100 %) but low sensitivity (0–66 %) for detection of PH, limiting screening utility while maintaining confirmatory value. AI-based algorithms achieved superior balanced diagnostic performance with sensitivity of 74–85 % and specificity of 85 %. AI algorithms also demonstrated early detection capability, identifying PH up to 2–5 years before conventional clinical diagnosis.

Conclusions

Traditional criteria retain value for diagnosis and response to therapy, while AI can be leveraged for early detection of PH. Implementation requires addressing computational infrastructure, healthcare provider training, and regulatory approval.

背景肺动脉高压（PH）具有显著的死亡风险，强调了改进早期发现策略的必要性。本文回顾了心电图评估在PH诊断中的演变，从传统标准到人工智能（AI）算法。方法回顾性分析1986 ~ 2025年间发表的24项研究，包括18项传统心电图验证研究和6项基于人工智能的研究。采用诊断准确性研究质量评估-2 （QUADAS-2）和QUADAS-AI框架评估方法学质量。研究按方法分类，并对诊断性能指标进行系统评估。结果传统心电图标准对PH的检测特异性高（71 ~ 100%），敏感性低（0 ~ 66%），在保持诊断价值的同时限制了筛查的实用性。基于人工智能的算法具有优异的平衡诊断性能，灵敏度为74 - 85%，特异性为85%。人工智能算法也展示了早期检测能力，比常规临床诊断早2-5年识别PH值。传统标准对诊断和治疗反应仍有价值，而人工智能可以用于早期发现ph。实施需要解决计算基础设施、医疗保健提供者培训和监管批准问题。

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引用次数: 0

Correlation of S100A8/A9 and AKT/NF-κB expression with severity and prognosis of type 2 diabetes mellitus complicated with severe pneumonia S100A8/A9、AKT/NF-κB表达与2型糖尿病合并重症肺炎严重程度及预后的相关性

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.rmed.2026.108650

Xiuyi Zhu , Shibo Wei , Aihong Chen , Qunqiong Zhong

Objective

To analyze the correlation between S100A8/A9, protein kinase B (AKT)/nuclear transcription factor κB (NF-κB) expression and the severity/prognosis of type 2 diabetes mellitus (T2DM) complicated with severe pneumonia, and provide a reference for improving clinical prognosis.

Methods

A total of 130 T2DM patients with severe pneumonia (study group) and 65 non-T2DM patients with severe pneumonia (control group) were enrolled. S100A8/A9 (protein) and AKT/NF-κB (mRNA) levels were compared. The study group was subdivided into mild (43 cases), moderate (55 cases), and severe (32 cases) subgroups based on APACHE II scores. Spearman correlation, receiver operating characteristic (ROC) curve, and relative risk (RR) were used to analyze correlation with severity, prognostic value, and prognosis-related risk, respectively.

Results

Molecular levels in the study group were higher than those in the control group (P < 0.05), increased with disease severity (mild < moderate < severe, P < 0.05) and were positively correlated with severity (all P < 0.05). Levels were lower in the good prognosis group than in the poor prognosis group (P < 0.05). The combined ROC AUC for prognosis was 0.919 (95 %CI: 0.859–0.960), exceeding that of individual markers (P < 0.05). High expression of each molecule was associated with a significantly increased risk of poor prognosis (RRs: 5.210, 3.771, 5.579, 4.105, respectively; all P < 0.05).

Conclusion

S100A8/A9 and AKT/NF-κB expression is closely related to the severity of T2DM complicated with severe pneumonia and holds prognostic value, with high expression indicating a higher risk of poor prognosis.

目的分析2型糖尿病（T2DM）合并重症肺炎患者S100A8/A9、蛋白激酶B (AKT)/核转录因子κB （NF-κB）表达与病情严重程度/预后的关系，为改善临床预后提供参考。方法选取T2DM合并重症肺炎患者130例（研究组）和非T2DM合并重症肺炎患者65例（对照组）。比较S100A8/A9（蛋白）和AKT/NF-κB （mRNA）水平。根据APACHE II评分将研究组分为轻度（43例）、中度（55例）和重度（32例）亚组。采用Spearman相关、受试者工作特征（ROC）曲线和相对危险度（RR）分别分析与病情严重程度、预后价值和预后相关风险的相关性。结果研究组患者分子水平高于对照组（P < 0.05），随病情严重程度增高（轻度<；中度<；重度，P < 0.05），与病情严重程度呈正相关（P < 0.05）。预后良好组低于预后不良组（P < 0.05）。预后的联合ROC AUC为0.919 (95% CI: 0.859 ~ 0.960)，超过单项指标（P < 0.05）。各分子高表达与预后不良风险显著升高相关（rr分别为5.210、3.771、5.579、4.105,P < 0.05）。结论s100a8 /A9和AKT/NF-κB的表达与T2DM合并重症肺炎的严重程度密切相关，具有预测预后的价值，表达越高，预后不良的风险越大。

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引用次数: 0

A prospective study of maintenance treatment for COPD patients hospitalised for severe exacerbations 慢性阻塞性肺病严重加重住院患者维持治疗的前瞻性研究

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.rmed.2026.108648

Paul W. Jones , Xiao Hu , Fen Dong , Ke Huang , Tiantian Liu , Tiantian Qi , Tao Ye , Yi Hu , Jianrong Li , Chen Wang , Ting Yang

Purpose

To quantify prescription of COPD maintenance treatment in patients hospitalised with an exacerbation.

Patients and methods

In this prospective study, COPD patients presenting in a stable state, or with an exacerbation, were recruited from 24 secondary and 15 tertiary care hospitals in China. This analysis concerns patients who were hospitalised. Maintenance treatment was recorded prior to admission, at discharge and 3 months post-discharge.

Results

A total of 615 patients were recruited, 279 from secondary and 336 from tertiary care; mean age 69 years, mean FEV₁ 45 % predicted, mean CAT score 19.1. All had one or more moderate/severe exacerbations in the previous year, mean 1.5 per year, mean hospitalisation 1.4 per year. Only 47 % reported using inhaled maintenance, triple therapy in 28 % and ICS/LABA in 18 %. Maintenance treatment was started in 88 % of patients who were not receiving it, but most patients on a dual therapy (≥69 %) were not stepped up. There was no difference between GOLD group C vs A or D vs B in treatment prescription suggesting that exacerbation history was not considered, however LAMA/LABA was associated with higher mMRC score, ICS/LABA with higher CAT score and triple therapy with GOLD grade.

Conclusions

Despite a high hospitalisation rate, there was under-use of treatment to reduce the risk of exacerbations and failure to step up patients on existing maintenance treatment when they had a severe exacerbation. There was an association between treatment and symptoms and airflow limitation, but physicians did not appear to select treatment based on exacerbation history.

目的：量化COPD加重住院患者的维持治疗处方。患者和方法：在这项前瞻性研究中，从中国24家二级和15家三级医院招募了状态稳定或病情加重的COPD患者。这一分析涉及住院患者。入院前、出院时和出院后3个月分别记录维持治疗情况。结果：共纳入615例患者，279例来自二级医疗机构，336例来自三级医疗机构；平均年龄69岁，平均FEV1预测45%，平均CAT评分19.1。所有患者在前一年都有一次或多次中度/重度恶化，平均每年1.5次，平均每年住院1.4次。只有47%的人报告使用吸入维持，28%的人使用三联治疗，18%的人使用ICS/LABA。88%未接受维持治疗的患者开始了维持治疗，但大多数接受双重治疗的患者（≥69%）没有加强治疗。GOLD组C组与A组或D组与B组的治疗处方没有差异，这表明没有考虑加重史，但LAMA/LABA组与较高的mMRC评分相关，ICS/LABA组与较高的CAT评分相关，三联治疗与GOLD级相关。结论：尽管住院率很高，但在降低恶化风险的治疗中使用率不足，当患者出现严重恶化时，未能加强现有的维持治疗。治疗与症状和气流限制之间存在关联，但医生似乎并未根据加重史选择治疗。

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引用次数: 0

Fractional exhaled nitric oxide in monitoring biological treatment for severe asthma in adults: Clinical implications and future perspectives 分式呼出一氧化氮监测成人严重哮喘生物治疗：临床意义和未来展望

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-12 DOI: 10.1016/j.rmed.2026.108647

Mauro Maniscalco , Claudio Candia , Pasquale Ambrosino , Maria Gabriella Matera , Mario Cazzola

Severe asthma (SA) is a heterogeneous disease that remains uncontrolled despite optimized, high-dose inhaled therapy. It is also associated with substantial morbidity, corticosteroid exposure, and a significant healthcare burden. The advent of targeted biologic therapies has transformed SA management, making accurate biomarker-guided phenotyping essential. Fractional exhaled nitric oxide (FeNO), a noninvasive biomarker of IL-4/IL-13–driven airway inflammation, is widely used in asthma; however, interpreting its levels in SA is complex. This narrative review provides a biology-driven analysis of FeNO in SA, focusing on mechanistic foundations, interpretive limitations, and biologic-specific behavior. Chronic exposure to high-dose inhaled or systemic corticosteroids, overlap with reference ranges in healthy populations, and common SA comorbidities, such as obesity, chronic rhinosinusitis with nasal polyps, and bronchiectasis, can substantially modify FeNO levels. This limits the usefulness of fixed cutoffs. We summarize the available evidence on FeNO dynamics across biologic classes, highlighting the rapid and pronounced suppression observed with anti-IL-4Rα and anti-TSLP therapies. This is in contrast to the variable and often modest changes seen with anti-IL-5/IL-5R agents. We also review data linking baseline FeNO values and early FeNO trajectories to clinical outcomes and asthma remission. FeNO should be integrated with blood eosinophils, IgE, sputum cytology, and clinical features to guide biologic selection and longitudinal monitoring, rather tham being used in isolation. Key evidence gaps include the need for prospective FeNO-guided biologic trials, harmonized SA-specific FeNO thresholds, and integration with multi-omics approaches to fully realize the full potential of FeNO as a precision biomarker in SA.

严重哮喘（SA）是一种异质性疾病，尽管优化了高剂量吸入治疗，但仍无法控制。它还与大量发病率、皮质类固醇暴露和重大医疗负担有关。靶向生物疗法的出现改变了SA的管理，使准确的生物标志物引导的表型至关重要。分式呼出一氧化氮（FeNO）是IL-4/ il -13驱动的气道炎症的无创生物标志物，广泛用于哮喘；然而，解释其在SA中的水平是复杂的。这篇叙述性综述提供了SA中FeNO的生物学驱动分析，重点是机制基础，解释局限性和生物学特异性行为。长期暴露于高剂量吸入或全身皮质类固醇，与健康人群的参考范围重叠，以及常见的SA合并症，如肥胖、慢性鼻窦炎伴鼻息肉和支气管扩张，可显著改变FeNO水平。这就限制了固定截止的用处。我们总结了不同生物类别的FeNO动态的现有证据，强调了抗il - 4r α和抗tslp治疗观察到的快速和明显的抑制。这与抗il -5/IL-5R药物的变化和通常温和的变化形成对比。我们还回顾了将基线FeNO值和早期FeNO轨迹与临床结果和哮喘缓解联系起来的数据。FeNO应与血嗜酸性粒细胞、IgE、痰细胞学和临床特征相结合，以指导生物学选择和纵向监测，而不是单独使用。关键的证据缺口包括需要前瞻性的FeNO引导的生物学试验，统一的SA特异性FeNO阈值，以及与多组学方法的整合，以充分发挥FeNO作为SA精确生物标志物的全部潜力。

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引用次数: 0

Peripheral muscle strength and lung function in adults with cystic fibrosis 囊性纤维化成人的外周肌力和肺功能。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.rmed.2025.108624

Taylor Lewis , Jacquelyn Spano , Jennifer Kwok , Richard Moss , Cory Smith , Paul K. Mohabir , Zachary M. Sellers , Kristen C. Cochrane- Snyman , Carlos Milla

Background

People with CF (pwCF) have decreased lung function, lean body mass, tensile strength, and exercise tolerance compared to age-matched healthy individuals. We investigated the relationship between peripheral muscle strength, pulmonary function, and inspiratory muscle strength in pwCF.

Methods

155 participants (51 % female, 35.2 ± 13.5 years-old; 49 % male, 35.6 ± 11.5 years-old) were evaluated for handgrip strength (HGS), forced vital capacity percent predicted (FVCpp), and forced expiratory volume in 1 s percent predicted (FEV1pp). A subset of participants (n = 86; 52 % female, 37.6 ± 13.2 years-old; 48 % male, 35.6 ± 11.5 years-old) underwent maximal inspiratory pressure (MIP) testing.

Results

Across the entire cohort, peak HGS and FVCpp were significantly correlated (P < 0.05). Multiple regression analyses identified that HGS, body mass index, physical activity, and resistance training were significant independent correlates of FVCpp in females, but not in males. No significant correlation was found between HGS and FEV1pp, but physical activity was correlated with FEV1pp in females (P < 0.05). MIP testing identified a correlation between HGS and inspiratory muscle strength (P < 0.001, r = 0.47), with males demonstrating a more pronounced association than females (P = 0.007, r = 0.41 vs. P = 0.144, r = 0.22, respectively).

Conclusion

In pwCF, HGS was associated with inspiratory muscle strength and FVCpp, underscoring its potential as a feasible adjunctive measure alongside lung function testing. These findings highlight resistance training as a modifiable target warranting further investigation to support both muscular and respiratory outcomes in this population.

背景：与年龄匹配的健康人相比，CF （pwCF）患者肺功能、瘦体重、抗拉强度和运动耐量下降。我们研究了pwCF患者外周肌力、肺功能和吸气肌力之间的关系。方法：对155名参与者（女性占51%，年龄35.2±13.5岁；男性占49%，年龄35.6±11.5岁）进行握力（HGS）、预测用力肺活量（FVCpp）和预测一秒用力呼气量（FEV1pp）的评估。一部分参与者（n=86； 52%的女性，37.6±13.2岁；48%的男性，35.6±11.5岁）接受了最大吸气压力（MIP）测试。结果：在整个队列中，HGS峰值与FVCpp显著相关（P < 0.05）。多元回归分析发现，HGS、体重指数、体力活动和阻力训练是女性FVCpp的显著独立相关因素，但在男性中没有。HGS与FEV1pp无显著相关，而体力活动与女性FEV1pp相关（P < 0.05）。MIP测试发现HGS与吸气肌力量之间存在相关性（P < 0.001, r = 0.47），男性比女性表现出更明显的相关性（P = 0.007, r = 0.41 vs. P = 0.144, r = 0.22）。结论：在pwCF中，HGS与吸气肌力量和FVCpp相关，强调其作为肺功能测试的可行辅助测量的潜力。这些发现强调阻力训练是一个可修改的目标，值得进一步研究，以支持该人群的肌肉和呼吸结果。

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引用次数: 0

Impact of home transcutaneous capnography on the assessment of patients with nocturnal hypoxemia 家庭经皮二氧化碳造影对夜间低氧血症患者评估的影响。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.rmed.2026.108643

Claudia Mañana Valdés , Ramon Fernandez Alvarez , Laura Abad Chamorro , Patricia Rodríguez Menéndez , Ines Ruiz Alvarez , Irene Fernandez Suarez , Maria Jose Vazquez Lopez , Pablo Lozano Cuesta , Ina Guerassimova , Guillermo López-Arranz Monge , Claudia Madrid Carbajal , Gemma Rubinos Cuadrado

Background

Sleep studies sometimes identify varying levels of hypoxemia through pulse oximetry; however, this does not distinguish between isolated hypoxemia and coexisting hypoventilation with hypercapnia. Transcutaneous capnography (TcCO2) correlates well with blood gas analysis and would be useful in these cases; however, there is limited information on its use at home in normocapnic patients with nocturnal hypoxemia. Our goal was to assess the impact of adding nocturnal TcCO2 measurement in this group of patients and to compare the measurement differences across different devices used.

Methods

A cross-sectional design was used to study normocapnic subjects with nocturnal hypoxemia detected during a sleep study. Home transcutaneous capnography and simultaneous pulse oximetry were performed. The study analyzed the detection of nocturnal hypoventilation, potential measurement differences between devices, and the impact on treatment decisions.

Results

Sixty-three subjects (64 ± 13 years; 54 % women) were included. Capnography was abnormal in 30 cases (48 %): 20 (32 %) with hypercapnia and 10 (16 %) with isolated hypoxemia. Specific treatment was recommended for 25 of the cases (83 %): 13 with CPAP and 12 with noninvasive ventilation. Differences between devices were observed in oxygenation data, as capnography measurements did not show hypoxemia in 52 % of the included cases.

Conclusions

Nocturnal TcCO2 monitoring at home can identify hypoventilation in patients without daytime hypercapnia and help guide suitable therapies. The differences in measurements compared to traditional pulse oximetry require further investigation.

背景：睡眠研究有时通过脉搏血氧仪识别不同程度的低氧血症；然而，这并不能区分孤立的低氧血症和共存的低通气伴高碳酸血症。经皮毛细血管造影（TcCO2）与血气分析有很好的相关性，在这些病例中是有用的；然而，关于其在夜间低氧血症患者家中使用的信息有限。我们的目的是评估在这组患者中增加夜间TcCO2测量的影响，并比较不同设备使用的测量差异。方法：采用横断面设计来研究在睡眠研究中发现的夜间低氧血症的正常capic受试者。家庭经皮血管造影和同步脉搏血氧测定。该研究分析了夜间低通气的检测、设备之间的潜在测量差异以及对治疗决策的影响。结果：纳入63例受试者（64±13岁，女性54%）。30例（48%）血糖异常：高碳酸血症20例（32%），低氧血症10例（16%）。25例（83%）推荐特殊治疗：13例CPAP， 12例无创通气。不同设备的氧合数据存在差异，因为在52%的纳入病例中，血液造影测量未显示低氧血症。结论：家中夜间TcCO2监测可识别无白天高碳酸血症患者的低通气，并指导合适的治疗。与传统脉搏血氧仪相比，测量结果的差异需要进一步研究。

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引用次数: 0

Efficacy of therapeutic bronchoscopic interventions in patients with unilateral total lung atelectasis secondary to lung cancer 支气管镜治疗对肺癌继发单侧全肺不张的疗效观察。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.rmed.2026.108635

Furkan Atasever , Cengiz Ozdemir , Celal Satici , Sinem Nedime Sokucu , Omer Ayten , Levent Dalar

Purpose

Malignant central airway obstruction (MCAO) secondary to lung cancer can result in unilateral total lung atelectasis, a life-threatening condition with limited data on survival outcomes and the role of therapeutic bronchoscopy. This study aimed to evaluate survival and prognostic factors in lung cancer patients with MCAO-induced total lung atelectasis and to assess the impact of bronchoscopic interventions.

Methods

We retrospectively analyzed 123 lung cancer patients with MCAO and unilateral total lung atelectasis treated at a single center. Of these, 84 underwent therapeutic bronchoscopic intervention, while 39 did not. Short-term survival (90-day mortality and median survival) was compared. Multivariate Cox regression was used to identify independent predictors of mortality.

Results

Overall, 60.2 % of patients died within 90 days. Bronchoscopic intervention was associated with lower 90-day mortality (52 % vs 77 %, p = 0.01) and longer median survival (88 vs 37 days, p < 0.001). Independent predictors of higher 90-day mortality included ECOG performance status 3–4, small cell lung cancer histology, stage IV disease, pulmonary artery (PA) invasion, extended lesions, and failure to restore airway patency. Among patients with PA invasion, recanalization did not improve survival (p = 0.34).

Conclusions

MCAO-induced total lung atelectasis in lung cancer patients is associated with poor short-term survival. Therapeutic bronchoscopy improves survival in selected patients, but its benefit is limited in the presence of PA invasion. Careful patient selection is critical when planning bronchoscopic intervention.

目的：肺癌继发的恶性中央气道阻塞（MCAO）可导致单侧全肺不张，这是一种危及生命的疾病，有关生存结局和支气管镜治疗作用的数据有限。本研究旨在评估mao诱导的肺癌全肺不张患者的生存和预后因素，并评估支气管镜干预的影响。方法：回顾性分析123例单侧全肺不张合并MCAO的肺癌患者。其中84例接受了支气管镜干预治疗，39例没有。比较短期生存期（90天死亡率和中位生存期）。采用多变量Cox回归来确定死亡率的独立预测因子。结果：总体而言，60.2%的患者在90天内死亡。支气管镜干预与较低的90天死亡率（52% vs 77%, p=0.01）和较长的中位生存期（88 vs 37天）相关。结论：mcao诱导的肺癌患者全肺不张与较差的短期生存相关。治疗性支气管镜检查可提高特定患者的生存率，但其益处在存在PA侵犯时是有限的。在计划支气管镜介入治疗时，仔细选择患者是至关重要的。

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引用次数: 0

Relationships between bronchodilator responsiveness, a COPD polygenic risk score, and COPD progression 支气管扩张剂反应性、COPD多基因风险评分和COPD进展之间的关系。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.rmed.2026.108636

Spyridon Fortis , Alejandro P. Comellas , Russell P. Bowler , Surya P. Bhatt , Craig P. Hersh , Dawn L. Demeo , Gregory Kinney , Edwin K. Silverman , Michael H. Cho , Matthew Moll

Introduction

Bronchodilator responsiveness (BDR) is associated with progression to COPD. Genetic risk for COPD, summarized by polygenic risk scores (PRS), predicts low lung function and COPD. However, it remains unclear whether genetic predisposition to COPD is related to BDR and whether PRS and BDR together influence lung function decline in individuals at risk for the disease.

Methods

We analyzed data from COPDGene participants with a smoking history and normal spirometry at study enrollment. We cross-sectionally examined the association of a PRS with 2005-BDR-FEV₁ % (change relative to pre-bronchodilator) and 2021-BDR-FEV₁ % (change relative to predicted). We also examined the association of PRS, 2005-BDR-FEV₁ %, and 2021-BDR-FEV₁ % with progression to COPD and longitudinal FEV₁ decline between enrollment and follow-up adjusted for demographics, smoking history, and FEV₁ at enrollment.

Results

PRS did not correlate with 2005-BDR-FEV₁ % in 1446 African Americans (AA) but PRS correlates with BDR in both unadjusted (rho = 0.01, P < 0.001) and adjusted analysis in 3378 non-Hispanic Whites (NHW). NHW participants with BDR had higher PRS than those without. Models including 2005-BDR-FEV1 % demonstrated better accuracy than those including PRS (Area under the curve: 0.762 vs 0.743 in NHW; 0.693 vs 0.653 in AA). BDR models also outperformed PRS models for longitudinal FEV₁ decline. Mediation analysis showed that about one third of the PRS effect on FEV₁ decline in NHW was explained through BDR.

Conclusions

BDR is more strongly associated with progression to COPD and FEV₁ decline than PRS, and part of the PRS effect is mediated through BDR.

支气管扩张剂反应性（BDR）与COPD进展相关。COPD的遗传风险，通过多基因风险评分（PRS）来总结，预测低肺功能和COPD。然而，目前尚不清楚COPD的遗传易感性是否与BDR有关，以及PRS和BDR是否共同影响该疾病风险个体的肺功能下降。方法：我们分析了在研究入组时具有吸烟史和正常肺活量测定的COPDGene参与者的数据。我们横断面研究了PRS与2005-BDR-FEV1%（相对于支气管扩张剂前的变化）和2021-BDR-FEV1%（相对于预测的变化）的关系。我们还研究了PRS、2005-BDR-FEV1%和2021-BDR-FEV1%与入组和随访期间COPD进展和纵向FEV1下降的关系，调整了人口统计学、吸烟史和入组时FEV1。结果：1446名非裔美国人（AA）的PRS与2005-BDR-FEV1%不相关，但在未调整的两组中PRS与BDR相关（rho=0.01， P1下降）。中介分析表明，约有三分之一的PRS效应可以通过BDR来解释。结论：与PRS相比，BDR与COPD进展和FEV1下降的相关性更强，部分PRS效应是通过BDR介导的。

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引用次数: 0

Interstitial pneumonia with autoimmune features: A literature review 具有自身免疫特征的间质性肺炎：文献综述

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine

Pub Date : 2026-01-09 DOI: 10.1016/j.rmed.2026.108641

Apostolos Perelas , Darryn L. Winter , Jeffrey J. Swigris , Mary E. Strek , Kristin B. Highland

Interstitial pneumonia with autoimmune features (IPAF) is a research classification for patients with an idiopathic interstitial pneumonia in whom clinical, serologic, and/or imaging features are consistent with an autoimmune process but criteria for a defined systemic autoimmune rheumatic disease are not met. Since the establishment of classification criteria in 2015, there has been research into the phenotypic and epidemiologic characteristics of the population, the implications of meeting IPAF criteria, the pathophysiologic processes at work, the factors associated with prognosis in patients meeting IPAF criteria, and its treatment. Despite this growing and evolving data, controversies remain around classification criteria, whether IPAF merits designation as a clinical diagnosis, and appropriate treatment regimens. In this review, we summarize the current state of knowledge about IPAF, discuss data that informs management decisions in patients meeting IPAF criteria, and highlight important questions for future research.

具有自身免疫性特征的间质性肺炎（IPAF）是特发性间质性肺炎患者的研究分类，这些患者的临床、血清学和/或影像学特征与自身免疫性过程一致，但不符合确定的系统性自身免疫性风湿病的标准。自2015年分类标准建立以来，人们对人群的表型和流行病学特征、符合IPAF标准的含义、起作用的病理生理过程、符合IPAF标准的患者预后相关因素及其治疗进行了研究。尽管这些不断增长和发展的数据，争议仍然围绕分类标准，是否IPAF值得指定为临床诊断，以及适当的治疗方案。在这篇综述中，我们总结了目前关于IPAF的知识状况，讨论了在符合IPAF标准的患者中为管理决策提供信息的数据，并强调了未来研究的重要问题。

引用次数: 0