心肺运动试验中的VE-VCO2斜率可预测慢性阻塞性肺疾病的急性加重：一项回顾性队列研究

摘要(中文译文)

心肺运动试验（CPET）是一种综合评估工具，用于评估慢性阻塞性肺疾病（COPD）患者在递增式自行车运动期间的心脏功能、呼吸反应和神经肌肉能力。CPET期间的VE-VCO2斜率在预测COPD急性加重（AECOPD）方面尚未完全清楚。本研究旨在建立基于VE-VCO2斜率的AECOPD预测模型。2013年至2019年间，共招募了79名慢性阻塞性肺病患者。所有参与者都接受了基线肺功能测试和CPET，并在之后随访了5年。使用独立的双样本t检验和卡方检验来比较AECOPD和非AECOPD组。采用单变量和多变量Cox回归分析来确定AECOPD的预测因素。通过受试者操作特征（ROC）曲线分析评估这些变量的诊断性能。尤登指数计算的最佳截止值。亚组之间的Kaplan-Meier生存分析基于最佳临界值。生成森林图以可视化Cox回归分析结果。AECOPD组包含62名参与者，非AECOPD小组包含17名参与者。各组比较显示，VE-VCO2斜率、年龄、BMI、预测FEV1%、FEV1/FVC比值和EqCO2存在显著差异。多变量Cox回归分析表明，VE-VCO2斜率（OR=1.19，95%CI:1.09-1.29，p<0.001）、年龄（OR=1.05，95%CI=1.02-1.09，p=0.005）和预测的FEV1%（OR=0.96，95%CI:0.94-0.99，p<0.015）是AECOPD的显著预测因素。关于上述预测因素的ROC曲线分析结果发现，VE-VCO2斜率的AUC在1年、3年和5年内独立最高，5年内的最佳临界值=28.42（风险比=3.18，95%CI:1.639-6.2，p<0.001）。VE-VCO2斜率≥28.42的分层是AECOPD的独立预测因素。我们的研究将VE-VCO2斜率确立为预测AECOPD的新型分层临床生物标志物。

Abstract

Cardiopulmonary Exercise Test (CPET) serves as an integrative assessment tool to evaluate cardiac function, respiratory responses, and neuromuscular capacity in patients with chronic obstructive pulmonary disease (COPD) during incremental cycling exercise. VE-VCO2 slope during CPET was not fully understood in predicting acute exacerbations of COPD (AECOPD). This study aims to establish a predictive model for AECOPD based on the VE-VCO2 slope. In total, 79 patients with COPD were recruited between 2013 and 2019. All participants underwent baseline pulmonary function tests and CPET and were followed up for 5 years thereafter. Independent two-sample -tests and Chi-square tests were used to compare AECOPD and Non-AECOPD groups. Univariate and multivariate Cox regression analyses were utilized to identify predictive factors for AECOPD. The diagnostic performance of these variables was evaluated by receiver operating characteristic (ROC) curve analysis. The optimal cutoff values calculated by Youden's index. Kaplan-Meier survival analysis between subgroups was based on the optimal cutoff values. Generating Forest plots to visualize Cox regression analysis results. The AECOPD group contains 62 participants and the Non-AECOPD group contains 17 participants. Groups comparisons revealed significant differences in VE-VCO2 slope, age, BMI, FEV1%predicted, FEV1/FVC ratio, and EqCO2. Multivariate Cox regression analysis identified VE-VCO2 slope (OR = 1.19, 95% CI: 1.09-1.29, p < 0.001), age (OR = 1.05, 95% CI: 1.02-1.09, p = 0.005), and FEV1%predicted (OR = 0.96, 95% CI : 0.94-0.99, p = 0.015) as significant predictors of AECOPD. The ROC curve analysis results about the above predictors found that the AUC of VE-VCO2 slope is highest independently in 1 year, 3 years and 5 years, with the optimal cutoff values = 28.42 in 5 years (hazard ratio = 3.18, 95% CI: 1.639-6.2, p < 0.001). The stratification of VE-VCO2 slope ≥28.42 was an independent predictor of AECOPD. Our study established VE-VCO2 slope as a novel stratified clinical biomarker for predicting AECOPD.

如何引用

International journal of chronic obstructive pulmonary disease 的其他文献

• 使用非对称插管接口增强慢性阻塞性肺疾病患者鼻高流量的呼吸支持：一项随机交叉研究
• 慢性阻塞性肺病急性加重危重患者住院死亡率多变量预测模型的开发和内部验证