美国布列根和妇女医院Alejandro A. Diaz团队研究了气道粘液堵塞与慢性阻塞性肺疾病患者死亡率的相关性。2023年5月21日出版的《美国医学会杂志》发表了这项成果。
气道粘液栓在慢性阻塞性肺病（COPD）患者中很常见；然而，COPD患者气道粘液堵塞与死亡率之间的关系尚不清楚。
为了确定胸部计算机断层扫描（CT）发现的气道粘液栓是否与全因死亡率增加有关，研究组对COPD遗传流行病学队列中诊断为COPD的患者进行了前瞻性收集数据的观察性回顾性分析。参与者为非西班牙裔黑人或白人，年龄在45至80岁之间，吸烟至少10包-年。参与者于2007年11月至2011年4月在美国21个中心注册，并随访至2022年8月31日。
暴露因素为在胸部CT扫描中发现完全阻塞气道的粘液塞（在中型至大型气道中发现）（即， 大概 2至10mm管腔直径），并分类为影响0、1至2或3个或更多肺节段。主要结局为全因死亡率，采用比例风险回归分析进行评估。模型根据年龄、性别、种族和民族、体重指数、吸烟包年数、当前吸烟状态、呼气第一秒用力呼气量以及肺气肿和气道疾病的CT测量进行了校正。
在4483名患有慢性阻塞性肺病的参与者中，4363人被纳入初步分析（中位年龄为63岁；44%为女性）。共有2585名（59.3%）、953名（21.8%）和825名（18.9%）参与者分别在0、1至2和3个或更多肺段出现粘液塞。在平均9.5年的随访中，1769名参与者（40.6%）死亡。在0、1至2和3个或更多肺节段出现粘液塞的参与者中，死亡率分别为34.0%、46.7%和54.1%。1至2个肺段与0个肺段、3个或更多肺段与0个肺段的粘液塞的存在校正后的死亡危险比分别为1.15和1.24相关。
研究结果表明，在COPD患者中，与胸部CT扫描中没有粘液堵塞的患者相比，阻塞中大型气道的粘液栓的存在与更高的全因死亡率相关。
Title: Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease
Author: Alejandro A. Diaz, José L. Orejas, Scott Grumley, Hrudaya P. Nath, Wei Wang, Wojciech R. Dolliver, Andrew Yen, Seth J. Kligerman, Kathleen Jacobs, Padma P. Manapragada, Mostafa Abozeed, Muhammad Usman Aziz, Mohd Zahid, Asmaa N. Ahmed, Nina L. Terry, Ruben San José Estépar, Victor Kim, Barry J. Make, MeiLan K. Han, Sushilkumar Sonavane, George R. Washko, Michael Cho, Raúl San José Estépar
Issue&Volume: 2023-05-21
Abstract:
Importance Airway mucus plugs are common in patients with chronic obstructive pulmonary disease (COPD); however, the association of airway mucus plugging and mortality in patients with COPD is unknown.
Objective To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality.
Design, Setting, and Participants Observational retrospective analysis of prospectively collected data of patients with a diagnosis of COPD in the Genetic Epidemiology of COPD cohort. Participants were non-Hispanic Black or White individuals, aged 45 to 80 years, who smoked at least 10 pack-years. Participants were enrolled at 21 centers across the US between November 2007 and April 2011 and were followed up through August 31, 2022.
Exposures Mucus plugs that completely occluded airways on chest CT scans, identified in medium- to large-sized airways (ie,approximately2- to 10-mm lumen diameter) and categorized as affecting 0, 1 to 2, or 3 or more lung segments.
Main Outcomes and Measures The primary outcome was all-cause mortality, assessed with proportional hazard regression analysis. Models were adjusted for age, sex, race and ethnicity, body mass index, pack-years smoked, current smoking status, forced expiratory volume in the first second of expiration, and CT measures of emphysema and airway disease.
Results Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively.
Conclusions and Relevance In participants with COPD, the presence of mucus plugs that obstructed medium- to large-sized airways was associated with higher all-cause mortality compared with patients without mucus plugging on chest CT scans.
DOI: 10.1001/jama.2023.2065
Source: https://jamanetwork.com/journals/jama/fullarticle/2805343
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex
本期文章：《美国医学会杂志》：Online/在线发表
