論文No4000
Pulmonary sarcoidosis: differences in lung function change over time (21 June, 2024)
Michelle Sharp, Kevin J Psoter, Ali M Mustafa, Edward S Chen, Nancy W Lin, Stephen C Mathai, Nisha A Gilotra, Michelle N Eakin, Robert A Wise, David R Moller, Meredith C McCormack
Thorax 2024;79:1033-1039.
要約
この研究は、サルコイドーシスという病気の患者さんの肺機能が、3年間でどのように変化するかを、様々な角度から調べたものです。具体的には、
肺機能のタイプ（拘束性、正常など）によって、肺機能の低下スピードが異なるか
人種（黒人、白人）や性別によって、肺機能の変化に違いがあるか
を分析しました。
主な結果として、
肺機能のタイプ：拘束性のタイプの人は、正常なタイプの人よりも、肺機能が早く悪くなる傾向が見られました。
人種：黒人の患者さんは、白人の患者さんよりも、最初から肺機能が低く、3年間の間にさらに悪くなる傾向が見られました。一方、白人の患者さんは、時間とともに肺機能が改善する傾向が見られました。
性別：性別による違いは、今回の研究では見られませんでした。
take home message
この研究から得られる重要な点は、サルコイドーシス患者の肺機能は、人によって大きく異なり、一概に同じように変化するわけではないということです。特に、肺機能のタイプや人種によって、肺機能の悪化スピードや経過が異なることがわかりました。
Introduction Given the heterogeneity of sarcoidosis, predicting disease course of patients remains a challenge. Our aim was to determine whether the 3-year change in pulmonary function differed between pulmonary function phenotypes and whether there were differential longitudinal changes by race and sex.
Methods We identified individuals seen between 2005 and 2015 with a confirmed diagnosis of sarcoidosis who had at least two pulmonary function test measurements within 3 years of entry into the cohort. For each individual, spirometry, diffusion capacity, Charlson Comorbidity Index, sarcoidosis organ involvement, diagnosis duration, tobacco use, race, sex, age and medications were recorded. We compared changes in pulmonary function by type of pulmonary function phenotype and for demographic groups.
Results Of 291 individuals, 59% (173) were female and 54% (156) were black. Individuals with restrictive pulmonary function phenotype had significantly greater 3-year rate of decline of FVC% (forced vital capacity) predicted and FEV1% (forced expiratory volume in 1 s) predicted course when compared with normal phenotype. We identified a subset of individuals in the cohort, highest decliners, who had a median 3-year FVC decline of 156 mL. Black individuals had worse pulmonary function at entry into the cohort measured by FVC% predicted, FEV1% predicted and diffusing capacity for carbon monoxide % predicted compared with white individuals. Black individuals’ pulmonary function remained stable or declined over time, whereas white individuals’ pulmonary function improved over time. There were no sex differences in rate of change in any pulmonary function parameters.
Summary We found significant differences in 3-year change in pulmonary function among pulmonary function phenotypes and races, but no difference between sexes.