胸部计算机断层扫描显示的气道粘液塞与慢性阻塞性肺疾病的病情加重有关。

IF 19.3 1区 医学 Q1 CRITICAL CARE MEDICINE American journal of respiratory and critical care medicine Pub Date : 2024-10-29 DOI:10.1164/rccm.202403-0632OC
Emily Wan, Andrew Yen, Rim Elalami, Scott Grumley, Hrudaya P Nath, Wei Wang, Sharon Brouha, Padma P Manapragada, Mostafa Abozeed, Muhammad Usman Aziz, Mohd Zahid, Asmaa N Ahmed, Nina L Terry, Pietro Nardelli, James C Ross, Victor Kim, Sushilkumar Sonavane, Seth J Kligerman, Jørgen Vestbo, Alvar Agusti, Kangjin Kim, Raul San José Estépar, Edwin K Silverman, Michael H Cho, Alejandro A Diaz
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引用次数: 0

摘要

理论依据/目的:慢性阻塞性肺疾病(COPD)的急性加重(AEs)与严重的发病率和死亡率有关。粘液栓是否与前瞻性加重有关尚未得到广泛研究:在两项多中心队列研究中,对全球慢性阻塞性肺病倡议(GOLD)2-4 级慢性阻塞性肺病吸烟者的基线胸部计算机断层扫描(CT)结果进行了粘液栓的视觉识别:这两项多中心队列研究分别是:慢性阻塞性肺病纵向评估以确定预测性替代终点(ECLIPSE)和慢性阻塞性肺病基因(COPDGene)。采用多变量调整零膨胀泊松回归法评估了粘液栓评分序数类别(0/1-2/≥3)与前瞻性确定的AEs(定义为需要使用全身类固醇和/或抗生素的呼吸道症状恶化(中度至重度)和/或急诊室/住院治疗(重度))之间的关系;受试者在入组时无病情加重:在COPDGene的3250名参与者(平均±SD年龄为63.7±8.4岁,FEV1预测值为50.6%±17.8%,女性占45.1%)和ECLIPSE的1716名参与者(年龄为63.3±7.1岁,FEV1预测值为48.3%±15.8%,女性占36.2%)中,分别有44.4%和46.0%的人有粘液栓。AE发生率分别为每100人年61.0例(COPDGene)和125.7例(ECLIPSE)。与没有粘液栓的患者相比,出现 1-2 个和≥3 个粘液栓与预期中度至重度 AE 风险增加有关(调整后比率比,aRR [95%CI]=1.07[1.05-1.09] 和 1.15[1.1-1.2](COPDGene;aRR=1.06[1.02-1.09]和 1.12[1.04-1.2](ECLIPSE))。1-2个和≥3个粘液栓的存在也与随访期间严重AEs风险的增加有关(COPDGene的aRR=1.05[1.01-1.08]和1.09[1.02-1.18];ECLIPSE的aRR=1.17[1.07-1.27]和1.37[1.15-1.62]):结论:基于 CT 的粘液栓与未来 COPD AE 风险的增加有关。
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Airway Mucus Plugs on Chest Computed Tomography Are Associated with Exacerbations in COPD.

Rationale/Objective: Acute exacerbations (AEs) of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality. Whether mucus plugs are associated with prospective exacerbations has not been examined extensively.

Methods: Mucus plugs were visually-identified on baseline chest computed tomography (CT) scans from smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 2-4 COPD enrolled in two multicenter cohort studies: Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and COPDGene. Associations between ordinal mucus plug score categories (0/1-2/≥3) and prospectively-ascertained AEs, defined as worsening respiratory symptoms requiring systemic steroids and/or antibiotics (moderate-to-severe) and/or ER/hospitalization (severe), were assessed using multivariable-adjusted zero-inflated Poisson regression; subjects were exacerbation-free at enrollment.

Results: Among 3,250 participants in COPDGene (mean±SD age 63.7±8.4 years, FEV1 50.6%±17.8% predicted, 45.1% female) and 1,716 participants in ECLIPSE (age 63.3±7.1 years, FEV1 48.3%±15.8% predicted, 36.2% female), 44.4% and 46.0% had mucus plugs, respectively. The incidence rates of AEs were 61.0 (COPDGene) and 125.7 (ECLIPSE) per 100 person-years. Relative to those without mucus plugs, the presence of 1-2 and ≥3 mucus plugs was associated with increased risk (adjusted rate ratio, aRR [95%CI]=1.07[1.05-1.09] and 1.15[1.1-1.2] in COPDGene; aRR=1.06[1.02-1.09] and 1.12[1.04-1.2] in ECLIPSE, respectively) for prospective moderate-to-severe AEs. The presence of 1-2 and ≥3 mucus plugs was also associated with increased risk for severe AEs during follow-up (aRR=1.05[1.01-1.08] and 1.09[1.02-1.18] in COPDGene; aRR=1.17[1.07-1.27] and 1.37[1.15-1.62] in ECLIPSE, respectively).

Conclusion: CT-based mucus plugs are associated with an increased risk for future COPD AEs.

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来源期刊
CiteScore
27.30
自引率
4.50%
发文量
1313
审稿时长
3-6 weeks
期刊介绍: The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences. A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
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