Mogulkoc N, Brutsche M H, Bishop P W, Murby B, Greaves M S, Horrocks A W, Wilson M, McCullough C, Prescott M, Egan J J
North West Lung Research Centre, South Manchester University Hospitals, NHS Trust, UK.
Thorax. 2001 Dec;56(12):916-23. doi: 10.1136/thorax.56.12.916.
Clearance of inhaled technetium 99m-labelled diethylenetriamine penta-acetic acid ((99m)Tc-DTPA) from the lungs is a potential indicator of disease progression in patients with idiopathic pulmonary fibrosis (IPF).
We prospectively analysed the usefulness of this technique for predicting survival in 106 non-smoking patients with usual interstitial pneumonia (UIP) pattern IPF diagnosed by high resolution CT (HRCT) scanning or histological examination (M/F 65/41, mean (SD) age 61 (11) years). DTPA clearance was analysed according to both mono-exponential and bi-exponential models. Half times for the fast (t(0.5)F) and slow (t(0.5)S) components of clearance, the percentage contribution of the fast component (fF), and half time for mono-exponential approximation to the early part of the clearance curve (t(0.5)) were calculated.
The patients had substantially faster t(0.5) (mean 23.9 (9.6) minutes) than normal values (>45 minutes). Thirty seven patients (35%) died during follow up (median 15 months). Univariate Cox regression analysis identified significant predictors of survival as age, forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), total lung capacity (TLC), % predicted TLC, carbon monoxide transfer factor (TLCO), % predicted TLCO, arterial oxygen tension (PaO(2)), oxygen saturation, t(0.5)F, and HRCT fibrosis score. Multiple stepwise Cox regression analysis identified t(0.5)F (p=0.03, hazard ratio 0.747, 95% CI 0.578 to 0.964), % predicted TLC (p=0.02, hazard ratio 0.976, 95% CI 0.956 to 0.995), % predicted TLCO (p=0.003, hazard ratio 0.960, 95% CI 0.935 to 0.986), and age (p=0.003, hazard ratio 1.062, 95% CI 1.021 to 1.104) as independent predictors of survival.
These data suggest that (99m)Tc-DTPA clearance t(0.5)F measurement may predict survival in patients with UIP pattern IPF.
吸入的锝99m标记的二乙三胺五乙酸（（99m）Tc-DTPA）从肺内的清除情况是特发性肺纤维化（IPF）患者疾病进展的一个潜在指标。
我们前瞻性分析了该技术对106例经高分辨率CT（HRCT）扫描或组织学检查确诊为普通型间质性肺炎（UIP）模式IPF的非吸烟患者生存预测的有效性（男/女65/41，平均（标准差）年龄61（11）岁）。根据单指数和双指数模型分析DTPA清除情况。计算清除快速成分（t(0.5)F）和缓慢成分（t(0.5)S）的半衰期、快速成分的贡献百分比（fF）以及清除曲线早期单指数近似的半衰期（t(0.5)）。
患者的t(0.5)（平均23.9（9.6）分钟）显著快于正常值（>45分钟）。37例患者（35%）在随访期间死亡（中位时间15个月）。单因素Cox回归分析确定生存的显著预测因素为年龄、第1秒用力呼气容积（FEV(1)）、用力肺活量（FVC）、肺总量（TLC）、预测TLC百分比、一氧化碳弥散量（TLCO）、预测TLCO百分比、动脉血氧分压（PaO(2)）、氧饱和度、t(0.5)F和HRCT纤维化评分。多因素逐步Cox回归分析确定t(0.5)F（p = 0.03，风险比0.747，95%置信区间0.578至0.964）、预测TLC百分比（p = 0.02，风险比0.976，95%置信区间0.956至0.995）、预测TLCO百分比（p = 0.003，风险比0.960，95%置信区间0.935至0.986）和年龄（p = 0.003，风险比1.062，95%置信区间1.021至1.104）为生存的独立预测因素。
这些数据表明，（99m）Tc-DTPA清除t(0.5)F测量可能预测UIP模式IPF患者的生存情况。
