Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
COPD. 2009 Dec;6(6):468-77. doi: 10.3109/15412550903341521.
The relationship between quantitative airway measurements on computed tomography (CT) and airflow limitation in individuals with severe alpha (1)-antitrypsin deficiency (AATD) is undefined. Thus, we planned to clarify the relationship between CT-based airway indices and airflow limitation in AATD. 52 patients with AATD underwent chest CT and pre-bronchodilator spirometry at three institutions. In the right upper (RUL) and lower (RLL) lobes, wall area percent (WA%) and luminal area (Ai) were measured in the third, fourth, and fifth generations of the bronchi. The severity of emphysema was also calculated in each lobe and expressed as low attenuation area percent (LAA%). Correlations between obtained measurements and FEV(1)% predicted (FEV(1)%P) were evaluated by the Spearman rank correlation test. In RUL, WA% of all generations was significantly correlated with FEV(1)%P (3rd, R = -0.33, p = 0.02; 4th, R = -0.39, p = 0.004; 5th, R = -0.57, p < 0.001; respectively). Ai also showed significant correlations (3rd, R = 0.32, p = 0.02; 4th, R = 0.34, p = 0.01; 5th, R = 0.56, p < 0.001; respectively). Measured correlation coefficients improved when the airway progressed distally from the third to fifth generations. LAA% also correlated with FEV(1)%P (R = -0.51, p < 0.001). In RLL, WA% showed weak correlations with FEV(1)%P in all generations (3rd, R = -0.34, p = 0.01; 4th, R = -0.30, p = 0.03; 5th, R = -0.31, p = 0.03; respectively). Only Ai from the fifth generation significantly correlated with FEV(1)%P in this lobe (R = 0.34, p = 0.01). LAA% strongly correlated with FEV(1)%P (R = -0.71, p < 0.001). We conclude therefore that quantitative airway measurements are significantly correlated with airflow limitation in AATD, particularly in the distal airways of RUL. Emphysema of the lower lung is the predominant component; however, airway disease also has a significant impact on airflow limitation in AATD.
在严重的α（1）-抗胰蛋白酶缺乏症（AATD）患者中，计算机断层扫描（CT）上的定量气道测量与气流受限之间的关系尚不清楚。因此，我们计划阐明 AATD 患者中基于 CT 的气道指数与气流受限之间的关系。52 名 AATD 患者在三个机构进行了胸部 CT 和支气管扩张前肺活量测定。在右上（RUL）和下（RLL）叶中，在支气管的第三、第四和第五代中测量壁面积百分比（WA％）和内腔面积（Ai）。还计算了每个叶中的肺气肿严重程度，并表示为低衰减面积百分比（LAA％）。通过 Spearman 秩相关检验评估获得的测量值与 FEV（1）％预测值（FEV（1）％P）之间的相关性。在 RUL 中，所有代的 WA％与 FEV（1）％P 显著相关（第 3 代，R =-0.33，p = 0.02；第 4 代，R =-0.39，p = 0.004；第 5 代，R =-0.57，p ＜0.001；分别）。Ai 也显示出显著相关性（第 3 代，R = 0.32，p = 0.02；第 4 代，R = 0.34，p = 0.01；第 5 代，R = 0.56，p ＜0.001；分别）。气道从第三代向第五代远端发展时，测量的相关系数会提高。LAA％也与 FEV（1）％P 相关（R =-0.51，p ＜0.001）。在 RLL 中，WA％在所有代中与 FEV（1）％P 呈弱相关（第 3 代，R =-0.34，p = 0.01；第 4 代，R =-0.30，p = 0.03；第 5 代，R =-0.31，p = 0.03；分别）。只有第五代的 Ai 与该叶的 FEV（1）％P 显著相关（R = 0.34，p = 0.01）。LAA％与 FEV（1）％P 强烈相关（R =-0.71，p ＜0.001）。因此，我们得出结论，定量气道测量与 AATD 中的气流受限显著相关，特别是在 RUL 的远端气道中。下肺的肺气肿是主要成分；然而，气道疾病对 AATD 中的气流受限也有重大影响。
