de Jong P A, Dodd J D, Coxson H O, Storness-Bliss C, Paré P D, Mayo J R, Levy R D
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Thorax. 2006 Sep;61(9):799-804. doi: 10.1136/thx.2005.053249. Epub 2006 May 2.
Computed tomographic (CT) scanning may enable earlier diagnosis of chronic lung allograft dysfunction than forced expiratory volume in 1 second (FEV1). A study was undertaken to determine intra-observer and inter-observer agreement of composite and air trapping CT scores, to examine the association of FEV1 with the composite and air trapping CT score, and to relate the baseline composite CT score to changes in FEV1 and changes in the composite CT score over 1 year.
Lung function and baseline CT scans following transplantation and at subsequent annual follow ups were analysed in 38 lung transplant recipients. Scans were randomly scored by two observers for bronchiectasis, mucus plugging, airway wall thickening, consolidation, mosaic pattern, and air trapping, and re-scored after 1 month. CT scores were expressed on a scale of 0-100 and correlated with FEV1 as a percentage of the post-transplant baseline value.
The mean (SD) interval between baseline and follow up CT scans was 11.2 (4.7) months. Inter-observer and intra-observer agreement was good for both the composite and air trapping CT scores. There was a significant association between FEV1 and the composite CT score, with each unit of worsening in the baseline composite CT score predicting a 1.55% and 1.37% worsening in FEV1 over the following year (p<0.0001) and a 1.25 and 1.12 unit worsening in the composite CT score (p<0.0001) for observers 1 and 2, respectively.
These findings indicate a potential role for a composite CT scoring system in the early detection of bronchiolitis obliterans.
计算机断层扫描（CT）可能比一秒用力呼气量（FEV1）能更早诊断慢性肺移植功能障碍。本研究旨在确定复合CT评分和空气潴留CT评分的观察者内和观察者间一致性，检验FEV1与复合CT评分和空气潴留CT评分的相关性，并将基线复合CT评分与1年内FEV1的变化以及复合CT评分的变化相关联。
对38例肺移植受者移植后及随后年度随访时的肺功能和基线CT扫描进行分析。扫描由两名观察者随机对支气管扩张、黏液嵌塞、气道壁增厚、实变、马赛克征和空气潴留进行评分，并在1个月后重新评分。CT评分以0-100分表示，并与FEV1作为移植后基线值的百分比相关。
基线和随访CT扫描之间的平均（标准差）间隔为11.2（4.7）个月。观察者间和观察者内对复合CT评分和空气潴留CT评分的一致性均良好。FEV1与复合CT评分之间存在显著相关性，基线复合CT评分每恶化1个单位，预测在接下来的一年中FEV1分别恶化1.55%和1.37%（p<0.0001），观察者1和观察者2的复合CT评分分别恶化1.25和1.12个单位（p<0.0001）。
这些发现表明复合CT评分系统在闭塞性细支气管炎的早期检测中具有潜在作用。
