Mair G, Miller J J, McAllister D, Maclay J, Connell M, Murchison J T, MacNee W
Medical Research Council Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK.
Eur Respir J. 2009 Mar;33(3):536-42. doi: 10.1183/09031936.00111808. Epub 2008 Oct 1.
Computed tomography (CT) scanning allows precise assessment of both the extent and distribution of emphysema. There has been little work on the relationship between the distribution of emphysema and clinical features of the disease. The current study investigated the association between clinical features and distribution of emphysema. A total of 129 patients with smoking-related chronic obstructive pulmonary disease underwent CT assessment of the extent and distribution of their emphysema (core/rind and upper/lower zone predominance). Emphysema was found predominantly in the upper/core zone and this distribution was related to the extent of disease. Core predominance was associated with lower forced expiratory volume in one second (FEV(1)), FEV(1)/forced vital capacity ratio and body mass index (BMI); and with higher BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) index and Medical Research Council dyspnoea score. Upper-zone predominance was associated with female sex and an increased total St George's Respiratory Questionnaire score. Using multiple linear regression age, sex and whole lung emphysema severity were independently associated with core/rind distribution, while sex and whole lung emphysema severity were independently related to upper/lower distribution. Distribution of emphysema related best to clinical features when divided into core/rind predominance. However, the effects were not independent of the extent of emphysema. Increased age and female sex were related to disease distribution independent of emphysema severity. These findings may be related to differences in development of emphysema.
计算机断层扫描（CT）可精确评估肺气肿的范围和分布。关于肺气肿分布与该疾病临床特征之间的关系，此前研究较少。本研究调查了临床特征与肺气肿分布之间的关联。共有129例与吸烟相关的慢性阻塞性肺疾病患者接受了CT检查，以评估其肺气肿的范围和分布（核心/边缘以及上/下叶优势）。肺气肿主要出现在上/核心区域，这种分布与疾病程度相关。核心区域优势与较低的一秒用力呼气容积（FEV₁）、FEV₁/用力肺活量比值和体重指数（BMI）相关；与较高的BODE（BMI、气流阻塞、呼吸困难和运动能力）指数以及医学研究委员会呼吸困难评分相关。上叶优势与女性性别以及圣乔治呼吸问卷总分增加相关。使用多元线性回归分析发现，年龄、性别和全肺气肿严重程度与核心/边缘分布独立相关，而性别和全肺气肿严重程度与上/下分布独立相关。当将肺气肿分布分为核心/边缘优势时，其与临床特征的相关性最佳。然而，这些影响并非独立于肺气肿的范围。年龄增加和女性性别与疾病分布相关，且独立于肺气肿严重程度。这些发现可能与肺气肿发展的差异有关。
