肺减容术后结局的生理和计算机断层扫描预测因子。
Physiological and computed tomographic predictors of outcome from lung volume reduction surgery.
机构信息
Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
出版信息
Am J Respir Crit Care Med. 2010 Mar 1;181(5):494-500. doi: 10.1164/rccm.200906-0911OC. Epub 2009 Dec 3.
RATIONALE
Previous investigations have identified several potential predictors of outcomes from lung volume reduction surgery (LVRS). A concern regarding these studies has been their small sample size, which may limit generalizability. We therefore sought to examine radiographic and physiologic predictors of surgical outcomes in a large, multicenter clinical investigation, the National Emphysema Treatment Trial.
OBJECTIVES
To identify objective radiographic and physiological indices of lung disease that have prognostic value in subjects with chronic obstructive pulmonary disease being evaluated for LVRS.
METHODS
A subset of the subjects undergoing LVRS in the National Emphysema Treatment Trial underwent preoperative high-resolution computed tomographic (CT) scanning of the chest and measures of static lung recoil at total lung capacity (SRtlc) and inspiratory resistance (Ri). The relationship between CT measures of emphysema, the ratio of upper to lower zone emphysema, CT measures of airway disease, SRtlc, Ri, the ratio of residual volume to total lung capacity (RV/TLC), and both 6-month postoperative changes in FEV(1) and maximal exercise capacity were assessed.
MEASUREMENTS AND MAIN RESULTS
Physiological measures of lung elastic recoil and inspiratory resistance were not correlated with improvement in either the FEV(1) (R = -0.03, P = 0.78 and R = -0.17, P = 0.16, respectively) or maximal exercise capacity (R = -0.02, P = 0.83 and R = 0.08, P = 0.53, respectively). The RV/TLC ratio and CT measures of emphysema and its upper to lower zone ratio were only weakly predictive of postoperative changes in both the FEV(1) (R = 0.11, P = 0.01; R = 0.2, P < 0.0001; and R = 0.23, P < 0.0001, respectively) and maximal exercise capacity (R = 0.17, P = 0.0001; R = 0.15, P = 0.002; and R = 0.15, P = 0.002, respectively). CT assessments of airway disease were not predictive of change in FEV(1) or exercise capacity in this cohort.
CONCLUSIONS
The RV/TLC ratio and CT measures of emphysema and its distribution are weak but statistically significant predictors of outcome after LVRS.
背景
先前的研究已经确定了肺减容手术（LVRS）结果的几个潜在预测因素。这些研究的一个关注点是它们的样本量小，这可能限制了其普遍性。因此，我们试图在一项大型多中心临床研究——国家肺气肿治疗试验中，检查与手术结果相关的放射学和生理学预测因素。
目的
确定与 LVRS 评估中的慢性阻塞性肺疾病患者的预后相关的客观放射学和肺疾病指标。
方法
国家肺气肿治疗试验中接受 LVRS 的患者亚组进行了术前胸部高分辨率计算机断层扫描（CT）检查和总肺容量时的静态肺回弹（SRtlc）和吸气阻力（Ri）测量。评估 CT 测量的肺气肿、上区与下区肺气肿比例、气道疾病 CT 测量、SRtlc、Ri、残气量与肺总量之比（RV/TLC）以及术后 6 个月时 FEV1 和最大运动能力的变化之间的关系。
测量和主要结果
肺弹性回弹和吸气阻力的生理测量与 FEV1 的改善均无相关性（R = -0.03，P = 0.78 和 R = -0.17，P = 0.16）或最大运动能力的改善（R = -0.02，P = 0.83 和 R = 0.08，P = 0.53）。RV/TLC 比值和 CT 测量的肺气肿及其上、下区比值仅与 FEV1（R = 0.11，P = 0.01；R = 0.2，P < 0.0001；R = 0.23，P < 0.0001）和最大运动能力（R = 0.17，P = 0.0001；R = 0.15，P = 0.002；R = 0.15，P = 0.002）的术后变化呈弱相关。该队列中气道疾病的 CT 评估与 FEV1 或运动能力的变化无关。
结论
RV/TLC 比值和 CT 测量的肺气肿及其分布是 LVRS 后结果的微弱但具有统计学意义的预测因素。
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