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【Am J Respir Crit Care Med】慢性阻塞性肺疾病病人死
The TORCH Experience
Bartolome Celli1, J?rgen Vestbo2,3, Christine R. Jenkins4, Paul W. Jones5, Gary T. Ferguson6, Peter M. A. Calverley7, Julie C. Yates8, Julie A. Anderson9, Lisa R. Willits9, Robert A. Wise10 on behalf of the investigators of the TORCH study
1 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; 2 Hvidovre Hospital, Hvidovre, Denmark; 3 Manchester Academic Health Science Centre, Manchester, United Kingdom; 4 Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia; 5 University of London, London, United Kingdom; 6 Pulmonary Research Institute of Southeast Michigan, Livonia, Michigan; 7 University Hospital Aintree, Liverpool, United Kingdom; 8 GlaxoSmithKline, Research Triangle Park, North Carolina; 9 GlaxoSmithKline, Middlesex, United Kingdom; and 10 Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland
Correspondence and requests for reprints should be addressed to Bartolome Celli, Ph.D., Pulmonary and Critical Care Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: bcelli@copdnet.org
Rationale: There is limited knowledge regarding sex differences and outcomes in patients with chronic obstructive pulmonary disease (COPD).
Objectives: Determine sex differences in survival, causes of death, and patient-centered outcomes in the 3-year Toward a Revolution in COPD Health (TORCH) study.
Methods: A total of 1,481 women and 4,631 men with COPD were enrolled in TORCH, a trial comparing salmeterol, 50 ?g, plus fluticasone propionate, 500 ?g, twice a day and each component individually. Causes of death were determined by an endpoint committee. Sex differences in survival were explored using a Cox proportional hazards model adjusted for other baseline factors. Exacerbation rate was compared using a negative binomial model. Dyspnea was evaluated using the Medical Research Council scale and health status using the St. George's Respiratory Questionnaire.
Measurements and Main Results: At baseline, women were younger (63 vs. 66 yr), had higher FEV1 (47% vs. 44% predicted), and worse St. George's Respiratory Questionnaire (51.3 vs. 48.7) and Medical Research Council score. During the study, 707 (15.3%) men and 168 (11.3%) women died. After adjusting for differences in baseline factors, the risk of dying was 16% higher in men than in women; however, this was not statistically significant (hazard ratio 1.16 [95% CI, 0.98–1.39]). Causes of death were similar in women and men. Exacerbation rate was 25% higher in women than in men.
Conclusions: Women enrolled in TORCH had a lower mortality rate than men but similar causes of death. The risk of dying was similar in women and men after adjusting for important baseline variables. Women reported more exacerbations, and worse dyspnea and health status scores than men.
Clinical trial registered with www.clinicaltrials.gov (NCT00268216).
Key Words: pulmonary disease, chronic obstructive ? sex ? mortality
AT A GLANCE COMMENTARY
Scientific Knowledge on the Subject
Although the incidence of chronic obstructive pulmonary disease in women is increasing, there is limited knowledge regarding the relationship between sex and mortality in this disease.
What This Study Adds to the Field
The Toward a Revolution in COPD Health study was designed to evaluate risk of death and its causes using an adjudication committee in over 6,000 patients of both sexes followed over 3 years. This study showed that women were 16% less likely to die over the period of the study than men. However, correcting for important covariates, such as degree of airflow obstruction, body mass index, region of the world, and previous myocardial infarction, this difference was not statistically significant. The causes of death were similar in men and women. Sex Differences in Mortality and Clinical Expressions of Patients with Chronic Obstructive Pulmonary Disease
慢性阻塞性肺疾病病人死亡率和临床特点的性别差异
The TORCH Experience
TORCH经验
Bartolome Celli1, J?rgen Vestbo2,3, Christine R. Jenkins4, Paul W. Jones5, Gary T. Ferguson6, Peter M. A. Calverley7, Julie C. Yates8, Julie A. Anderson9, Lisa R. Willits9, Robert A. Wise10 on behalf of the investigators of the TORCH study
1 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; 2 Hvidovre Hospital, Hvidovre, Denmark; 3 Manchester Academic Health Science Centre, Manchester, United Kingdom; 4 Woolcock Institute of Medical Research, Camperdown, New South Wales, Australia; 5 University of London, London, United Kingdom; 6 Pulmonary Research Institute of Southeast Michigan, Livonia, Michigan; 7 University Hospital Aintree, Liverpool, United Kingdom; 8 GlaxoSmithKline, Research Triangle Park, North Carolina; 9 GlaxoSmithKline, Middlesex, United Kingdom; and 10 Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland
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作者:admin@医学,生命科学 2011-02-11 02:50
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