Stavngaard Trine, Shaker Saher B, Dirksen Asger
Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen, Rigshospitalet, 4011, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Respir Med. 2006 Jan;100(1):94-100. doi: 10.1016/j.rmed.2005.04.001.
Identification of upper lobe emphysema is mandatory before lung volume reduction surgery (LVRS). Here we introduce a CT-based objective model for describing the distribution of different types of emphysema.
Fifty COPD patients were included in the study. Half had alpha1-antitrypsin deficiency (alpha1-COPD) and the rest had smoking-induced emphysema (usual COPD). All patients were scanned 3 times. The relative area of emphysema in each CT slice was plotted against table position, and the cranio-caudal distribution was calculated as the slope of the regression line.
The variation in slopes within a patient was much less than the variation in slopes between patients (P<0.0001). There was a significant difference between slopes in the alpha1-COPD and the usual COPD groups (P<0.0001). In the alpha1-COPD group, 24/25 patients had lower lobe emphysema. In the usual COPD group, 4 patients had upper lope predominance, 5 patients had heterogeneous distributions, and 16 patients had lower lobe predominance.
The majority of patients with smoking-related emphysema have a homogeneous distribution and lower lobe predominance although not as noticeable as in alpha1-antitrypsin deficiency. An objective and quantitative method for determining the distribution of emphysema should be applied when selecting candidates for LVRS.
在进行肺减容手术（LVRS）之前，必须先确定上叶肺气肿。在此，我们介绍一种基于CT的客观模型，用于描述不同类型肺气肿的分布情况。
本研究纳入了50例慢性阻塞性肺疾病（COPD）患者。其中一半患有α1-抗胰蛋白酶缺乏症（α1-COPD），其余患者患有吸烟所致的肺气肿（普通COPD）。所有患者均进行了3次扫描。将每个CT切片中肺气肿的相对面积与表格位置作图，并将颅尾分布计算为回归线的斜率。
患者内部斜率的变化远小于患者之间斜率的变化（P<0.0001）。α1-COPD组和普通COPD组的斜率存在显著差异（P<0.0001）。在α1-COPD组中，24/25的患者患有下叶肺气肿。在普通COPD组中，4例患者以上叶为主，5例患者分布不均，16例患者以下叶为主。
大多数吸烟相关性肺气肿患者的分布均匀且以下叶为主，尽管不如α1-抗胰蛋白酶缺乏症患者明显。在选择LVRS候选者时，应采用一种客观定量的方法来确定肺气肿的分布。
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