肺气肿患者内镜下肺减容术后的结局性别差异：德国肺气肿登记回顾性分析
该回顾性分析基于德国肺气肿登记（2017年1月至2025年1月）数据，纳入778例接受支气管镜活瓣置入的肺气肿患者（女性378例，47.2%），评估ELVR结局的性别差异。结果显示男女在FEV1%、RV%等功能指标变化上无显著差异，但女性CAT和SGRQ评分改善更明显，女性性别是SGRQ应答的独立预测因素（OR 1.89）。
要点
- 女性基线FEV1%和肺活量%略优于男性，但CAT症状评分更高。
- 3个月随访时男女FEV1%、RV%和DLCO%变化无显著差异。
- 女性CAT和SGRQ评分改善显著优于男性，女性性别是SGRQ应答独立预测因素。
核心结论
- 性别可能不影响ELVR后的生理指标结局，但可能影响症状严重程度和生活质量。
- 女性性别是SGRQ应答的独立预测因素（OR 1.89）。
研究设计与样本
- 回顾性分析，使用德国肺气肿登记（LER e.V.）2017年1月至2025年1月数据。
- 最终分析纳入778例接受支气管镜活瓣置入的肺气肿患者，女性378例（47.2%），平均年龄65.9±7.6岁。
主要发现
- 基线女性FEV1%为31.4±8.5 vs 男性28.1±8.1（p<0.001），肺活量%为63.6±16.9 vs 59.2±14.8（p<0.001），RV%相似。
- 男性冠状动脉疾病（20.9% vs 11.7%）和心房颤动（7.3% vs 3.5%）发生率更高（p<0.05）。
- 女性基线CAT评分更高（25.9±6.1 vs 24.9±6.1，p<0.001），SGRQ评分相似。
- 3个月随访574例患者，ΔFEV1%、ΔRV%和ΔDLCO%无性别差异。
- ΔCAT评分（-4.3±6.8 vs -1.9±6.1，p<0.001）和ΔSGRQ（-13.2±17.3 vs -5.5±12.48，p<0.001）存在性别差异，呼吸困难无差异。
关键数值与推荐
- 女性性别对SGRQ应答的OR为1.89。
- 肺气肿异质性对SGRQ应答的OR为1.01。
- ΔRV对SGRQ应答的OR为0.73。
临床怎么用
- ELVR疗效评估中应关注性别对症状和生活质量结局的潜在影响。
- 女性患者可能从ELVR中获得更大的症状和生活质量改善。
局限性
- 回顾性分析设计。
- 3个月随访仅覆盖574例患者。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Endoscopic lung volume reduction (ELVR) is increasingly used for treating patients with chronic obstructive pulmonary disease (COPD) and severe hyperinflation. Data on sex differences in ELVR outcomes are lacking, highlighting the need for detailed analysis. METHODS: This retrospective analysis examines sex-specific outcomes of ELVR with bronchoscopic valve placement using data from the German Lung Emphysema Registry (January 2017 to January 2025). RESULTS: The final analysis included 778 patients, 378 (47.2%) women, mean age 65.9±7.6 years. No significant differences in age or body mass index. At baseline, women had slightly better forced expiratory volume in 1 s (FEV1)% (31.4±8.5 vs 28.1±8.1, p<0.001) and vital capacity% (63.6±16.9 vs 59.2±14.8, p<0.001), but similar residual volume (RV)%. Men had higher rates of cardiovascular diseases, including coronary artery disease (20.9% vs 11.7%) and atrial fibrillation (7.3% vs 3.5%), p<0.05. Despite this, women reported a higher symptom burden with higher COPD Assessment Test (CAT) scores (25.9±6.1 vs 24.9±6.1, p<0.001), but similar St. George's Respiratory Questionnaire (SGRQ) scores. Follow-up at 3 months for 574 patients showed no sex differences in ΔFEV1%, ΔRV% or Δdiffusing capacity of the lung for carbon monoxide%. Differences in treatment response were noted for ΔCAT score (-4.3±6.8 vs -1.9±6.1, p<0.001), ΔSGRQ (-13.2±17.3 vs -5.5±12.48, p<0.001), but not for dyspnoea. Multivariable analyses showed female sex (OR 1.89) as an independent predictor for SGRQ response, along with emphysema heterogeneity (OR 1.01) and pulmonary function response (ΔRV, OR 0.73). CONCLUSIONS: Sex may not influence physiological outcomes but may impact symptom severity and quality of life, raising the question of whether sex should be considered when determining minimal clinically important differences in COPD.
引用
- Atug E, Trudzinski FC, Holland A, et al. Sex differences in outcome after endoscopic lung volume reduction (ELVR) in patients with emphysema: a retrospective analysis of the German Lung Emphysema Registry (LER e.V.). Thorax. 2026. PMID: 41232944. doi:10.1136/thorax-2025-223559
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。