Ingenito E P, Loring S H, Moy M L, Mentzer S J, Swanson S J, Hunsaker A, McKee C C, Reilly J J
Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Respir Crit Care Med. 2001 Apr;163(5):1068-73. doi: 10.1164/ajrccm.163.5.9911013.
Physiological and radiological criteria are both used to identify candidates for LVRS. This study compares the predictive value of these screening techniques among patients with homogeneous (Ho) and heterogeneous (He) emphysema. Preoperative inspiratory lung conductance (G(Li)) during spontaneous breathing and quantitative radioisotope V/Q scan (QVQS) results were available for 48 of 50 patients undergoing bilateral LVRS for emphysema. Ho disease (n = 21) was defined by QVQS as an upper/lower perfusion ratio (ULPR) between 0.75 and1.25. G(Li) correlated with 6-mo improvement in FEV(1) (DeltaFEV(1)-6) (r = 0.53, p < 0.001) for the entire cohort, and for patients with both Ho (n = 21, r = 0.56, p = 0.015) and He disease (n = 27, r = 0.46, p = 0.017). ULPR correlated less well with DeltaFEV(1)-6 (n = 48, r = -0.38; p = 0.008) for the cohort, and was significantly correlated with outcomes only in the subgroup of patients with He disease (r = -0.40, p = 0.04). Multivariate regression demonstrated that by combining G(Li) and ULPR criteria, 33% of the DeltaFEV(1)-6 response could be accounted for. We conclude that both physiological and radiological criteria help identify appropriate candidates for LVRS. G(Li) best identifies patients with Ho emphysema who may benefit from surgery, but would be excluded on the basis of strictly radiological criteria. ULPR helps identify patients with He disease that improves with surgery, despite unfavorable G(Li).
生理和放射学标准都用于确定肺减容术（LVRS）的候选者。本研究比较了这些筛查技术在均匀性（Ho）和非均匀性（He）肺气肿患者中的预测价值。50例因肺气肿接受双侧LVRS的患者中有48例可获得术前自主呼吸时的吸气肺传导率（G(Li)）和定量放射性核素通气/灌注扫描（QVQS）结果。根据QVQS，Ho型疾病（n = 21）定义为上/下灌注比（ULPR）在0.75至1.25之间。对于整个队列，以及Ho型（n = 21，r = 0.56，p = 0.015）和He型疾病（n = 27，r = 0.46，p = 0.017）患者，G(Li)与第6个月时FEV(1)的改善情况（DeltaFEV(1)-6）相关（r = 0.53，p < 0.001）。对于该队列，ULPR与DeltaFEV(1)-6的相关性较差（n = 48，r = -0.38；p = 0.008），仅在He型疾病患者亚组中与预后显著相关（r = -0.40，p = 0.04）。多变量回归表明，结合G(Li)和ULPR标准，可以解释33%的DeltaFEV(1)-6反应。我们得出结论，生理和放射学标准都有助于确定适合LVRS的候选者。G(Li)最能识别可能从手术中获益但根据严格的放射学标准会被排除的Ho型肺气肿患者。尽管G(Li)不理想，但ULPR有助于识别手术可改善的He型疾病患者。
