本病无法被根治,而许多患者,尤其是非吸烟者,具有正常的预期寿命。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com[47]Seersholm N, Kok-Jensen A, Dirksen A. Survival of patients with severe alpha-1 antitrypsin deficiency with special reference to non-index cases. Thorax. 1994;49:695-698.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475060/pdf/thorax00299-0073.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8066566?tool=bestpractice.com
肺病
50%到72%的AAT 缺乏症死亡病例是由于呼吸衰竭导致的,后者超过了肝功能衰竭所造成的死亡比例。[21]Larsson C. Natural history and life expectancy in severe alpha 1-antitrypsin deficiency, Pi Z. Acta Med Scand. 1978;204:345-351.http://www.ncbi.nlm.nih.gov/pubmed/309708?tool=bestpractice.com[50]Alpha-1-Antitrypsin Deficiency Registry Study Group. Survival and FEV1 decline in individuals with severe deficiency of alpha 1-antitrypsin. Am J Respir Crit Care Med. 1998;158:49-59.http://www.ncbi.nlm.nih.gov/pubmed/9655706?tool=bestpractice.com[82]Dawkins PA, Dowson LJ, Guest PJ, et al. Predictors of mortality in alpha 1-antitrypsin deficiency. Thorax. 2003;58:1020-1026.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746543/pdf/v058p01020.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/14645964?tool=bestpractice.com 有证据表明,由于早发肺气肿和渐进性肺病,AAT 缺乏症的中位死亡年龄在吸烟者中为 40 岁,而在非吸烟者中则为 65 岁。[21]Larsson C. Natural history and life expectancy in severe alpha 1-antitrypsin deficiency, Pi Z. Acta Med Scand. 1978;204:345-351.http://www.ncbi.nlm.nih.gov/pubmed/309708?tool=bestpractice.com 评估该病的自然过程的证据还很有限,但对于本病的肺病表现的长期预后的评估已完成。
FEV1应当作为预测患者生存的一项重要指标,而2年死亡率与FEV>35%之间的相关性已被确定。[83]Seersholm N, Dirksen A, Kok-Jensen A. Airways obstruction and two-year survival in patients with severe alpha-1 antitrypsin deficiency. Eur Respir J. 1994;7:1985-1987.http://www.ncbi.nlm.nih.gov/pubmed/7875269?tool=bestpractice.com FEV1的下降速度在从未吸烟者中为47-80 毫升每年,在已戒烟者中为41-81 毫升每年,而在吸烟者中为61-316 毫升每年。[35]Janus ED, Phillips NT, Carrell RW. Smoking, lung function, and alpha-1-antitrypsin deficiency. Lancet. 1985;1:152-154.http://www.ncbi.nlm.nih.gov/pubmed/2857224?tool=bestpractice.com[36]Wu MC, Eriksson S. Lung function, smoking and survival in severe alpha 1-antitrypsin deficiency, PiZZ. J Clin Epidemiol. 1988;41:1157-1165.http://www.ncbi.nlm.nih.gov/pubmed/3264848?tool=bestpractice.com[37]Piitulainen E, Eriksson S. Decline in FEV1 related to smoking status in individuals with severe alpha-1 antitrypsin deficiency (PiZZ). Eur Respir J. 1999;13:247-251.http://erj.ersjournals.com/cgi/reprint/13/2/247http://www.ncbi.nlm.nih.gov/pubmed/10065663?tool=bestpractice.com AAT 强化治疗可以有效地减缓肺病放射影像学证据,同时有助于降低死亡率。[51]Dirksen A, Dijkman JH, Madsen F, et al. A randomized clinical trial of alpha 1-antitrypsin augmentation therapy. Am J Respir Crit Care Med. 1999;160:1468-1472.http://www.ncbi.nlm.nih.gov/pubmed/10556107?tool=bestpractice.com[50]Alpha-1-Antitrypsin Deficiency Registry Study Group. Survival and FEV1 decline in individuals with severe deficiency of alpha 1-antitrypsin. Am J Respir Crit Care Med. 1998;158:49-59.http://www.ncbi.nlm.nih.gov/pubmed/9655706?tool=bestpractice.com
肺移植后的五年生存率约为50%。[68]Hosenpud JD, Novick RJ, Breen TJ, et al. The registry of the International Society for Heart and Lung Transplanation: twelfth official report. J Heart Lung Transplant. 1995;14:805-815.http://www.ncbi.nlm.nih.gov/pubmed/8800714?tool=bestpractice.com[69]Levine SM, Anzueto A, Peters JI, et al. Medium term functional results of single-lung transplantation for end stage obstructive lung disease. Am J Respir Crit Care Med. 1994;150:398-402.http://www.ncbi.nlm.nih.gov/pubmed/8049821?tool=bestpractice.com 中位生存期为 6.3 年。[70]Christie JD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: twenty-eighth adult lung and heart-lung transplant report - 2011. J Heart Lung Transplant. 2011;30:1104-1122.http://www.jhltonline.org/article/S1053-2498%2811%2901089-8/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/21962018?tool=bestpractice.com
肝病
携带PI*ZZ而又未表现肺部症状的患者更可能经历肝硬化以及最终的肝功能衰竭。[84]Eriksson S. Alpha 1-antitrypsin deficiency: natural course and therapeutic strategies. In: Boyer J, Blum HE, Maier KP, et al, eds. Cirrhosis and its development. Falk Symposium 115. Dordrecht, Netherlands: Kluwer Academic; 2000:307-315. PI*ZZ个体的终身患病率介于10%与34%之间。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com 年龄较大且为纯合基因型的患者中,三分之一将死于门静脉高压与原发性肝癌相关的并发症。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com