来自作者:
我们感谢M. Mura提醒我们发表在欧洲呼吸杂志(ERJ) in 2012 that confirmed the increasing importance of the 6-min walk test (6MWT) in the evaluation and prediction of outcome in patients suffering from idiopathic pulmonary fibrosis (IPF) [1]。In this prospective study by M乌拉et al.[1], of factors that predicted survival in 70 patients with newly diagnosed IPF, the major 6MWT findings were that the 6-min walk distance (6MWD) % predicted, but not 6MWD defined as metres walked, was independently associated with 3-year survival, and that a receiver operating characteristic-based cut-off of 72% pred 6MWD best differentiated probable outcome.
By contrast, our data recently reported in theERJshowed that both baseline and especially 24-week change in 6MWD, defined as metres walked, were independent predictors of outcome [2]。在我们的研究中,我们没有探索6MWD%的预测,因为M. Mura提到的参考方程问题。使用标准化6MWT方法来自健康基于人群样本的参考方程尚不可用[3]。M的研究乌拉et al.[1] used the equations that were derived from a study of 173 healthy females and 117 healthy males from Tuscon, AZ, USA [4] and, therefore, are possibly not representative of the Italian individuals who participated in their study. Given that our study included 748 patients who had enrolled in a clinical trial in 81 centres in seven European countries, the USA and Canada, we felt that it would not be appropriate to derive percent predicted values based on data from a single state in the USA. The highlights of our study were that 6MWD provided a prediction of mortality that was independent of other indices previously reported by us [5],并且与原始模型相比,在临床预测模型中添加6MWD可以改善模型歧视[2]。
The findings of the study reported by M乌拉et al.[1], combined with those of our own recent study [2],提供令人信服的证据,以支持6MWD在临床实践和设计新疗法临床试验的终点中的实用性,并加强了几项早期研究的数据,这些数据显示了IPF患者6MWD的有利性能特征[6–8]。Recently, this index of evaluation has appeared to have fallen out of favour but the complementary positive data provided by our study and that of M乌拉et al.[1] support the use of the 6MWT as a future end-point. To abandon an index prematurely would do a disservice to our patients if added value due to its continued use to predict probable outcome accrued, which would in turn be of value when considering the initiation of, or change in, therapy and the timing of referral for lung transplantation.
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- 已收到2014年1月4日。
- AcceptedJanuary 7, 2014.
- ©ERS 2014