Stolk Jan, Putter Hein, Bakker Els M, Shaker Saher B, Parr David G, Piitulainen Eeva, Russi Erich W, Grebski Elzbieta, Dirksen Asger, Stockley Robert A, Reiber Johan H C, Stoel Berend C
Department of Pulmonology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Respir Med. 2007 Sep;101(9):1924-30. doi: 10.1016/j.rmed.2007.04.016. Epub 2007 Jul 20.
In patients with airflow limitation caused by cigarette smoking, lung density measured by computed tomography is strongly correlated with quantitative pathology scores of emphysema, but the ability of lung densitometry to detect progression of emphysema is disputed. We assessed the sensitivity of lung densitometry as a parameter of disease progression of emphysema in comparison to FEV(1) and gas transfer. At study baseline and after 30 months we measured computed tomography (CT)-derived lung density, spirometry and carbon monoxide diffusion coefficient in 144 patients with chronic obstructive pulmonary disease (COPD) in five different centers. Annual change in lung density was 1.31 g/L/year (CI 95%: -2.12 to -0.50 HU, p=0.0015, 39.5 mL/year (CI 95%: -100.0-21.0 mL, p=0.2) for FEV(1) (-39.5 mL) and 24.3 micromol/min/kPa/L/year for gas transfer (CI 95%: -61.0-12.5 micromol/min/kPa/L/year, p=0.2). Signal-to-noise ratio (mean change divided by standard error of the change) for the detection of annual change was 3.2 for lung densitometry, but 1.3 for both FEV(1) and gas diffusion. We conclude that detection of progression of emphysema was found to be 2.5-fold more sensitive using lung densitometry than by using currently recommended lung function parameters. Our results support CT scan as an efficacious test for novel drugs for emphysema.
在因吸烟导致气流受限的患者中，通过计算机断层扫描测量的肺密度与肺气肿的定量病理学评分密切相关，但肺密度测定法检测肺气肿进展的能力存在争议。我们将肺密度测定作为肺气肿疾病进展参数的敏感性与第一秒用力呼气容积（FEV₁）和气体交换进行了比较。在研究基线和30个月后，我们在五个不同中心对144例慢性阻塞性肺疾病（COPD）患者进行了计算机断层扫描（CT）衍生的肺密度、肺量计检查和一氧化碳弥散系数测量。肺密度的年变化为1.31 g/L/年（95%置信区间：-2.12至-0.50 HU，p = 0.0015），FEV₁为-39.5 mL/年（95%置信区间：-100.0至21.0 mL，p = 0.2），气体交换为24.3 μmol/min/kPa/L/年（95%置信区间：-61.0至12.5 μmol/min/kPa/L/年，p = 0.2）。检测年度变化的信噪比（平均变化除以变化的标准误差），肺密度测定法为3.2，而FEV₁和气体弥散均为1.3。我们得出结论，发现使用肺密度测定法检测肺气肿进展的敏感性比使用目前推荐的肺功能参数高2.5倍。我们的结果支持CT扫描作为检测治疗肺气肿新药的有效试验。
