Shaker Saher Burhan, Stavngaard Trine, Hestad Marianne, Bach Karen Skjoelstrup, Tonnesen Philip, Dirksen Asger
Department of Cardiology and Respiratory Medicine, Hvidovre Hospital, Copenhagen, Denmark.
Clin Respir J. 2009 Jan;3(1):15-21. doi: 10.1111/j.1752-699X.2008.00102.x.
The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate this extent to the GOLD stage of airway obstruction.
We included 209 patients with COPD. COPD was defined as FEV(1)/FVC < 0.70 and no reversibility to beta(2)-agonists. All patients were current smokers with a smoking history of >or=20 pack-years. Patients were assessed by lung function measurement and visual and quantitative assessment of CT, from which the relative area of emphysema below -910 Hounsfield units (RA-910) was extracted.
Mean RA-910 was 7.4% (n = 5) in patients with GOLD stage I, 17.0% (n = 119) in stage II, 24.2% (n = 79) in stage III and 33.9% (n = 6) in stage IV. Regression analysis showed a change in RA-910 of 7.8% with increasing severity according to GOLD stage (P < 0.001). Combined visual and quantitative assessment of CT showed that 184 patients had radiological evidence of emphysema, whereas 25 patients had no emphysema.
The extent of emphysema increases with increasing severity of COPD and most patients with COPD have emphysema. Tissue destruction by emphysema is therefore an important determinant of disease severity in COPD.
慢性阻塞性肺疾病全球倡议（GOLD）采用气道阻塞程度作为疾病严重程度的衡量指标。本研究的目的是应用CT评估慢性阻塞性肺疾病（COPD）患者的肺气肿程度，并将该程度与气道阻塞的GOLD分期相关联。
我们纳入了209例COPD患者。COPD定义为FEV(1)/FVC < 0.70且对β(2) - 激动剂无反应。所有患者均为现吸烟者，吸烟史≥20包年。通过肺功能测量以及CT的视觉和定量评估对患者进行评估，从中提取低于 - 910亨氏单位的肺气肿相对面积（RA - 910）。
GOLD I期患者的平均RA - 910为7.4%（n = 5），II期为17.0%（n = 119），III期为24.2%（n = 79），IV期为33.9%（n = 6）。回归分析显示，根据GOLD分期，随着严重程度增加，RA - 910变化7.8%（P < 0.001）。CT的视觉和定量综合评估显示，184例患者有肺气肿的影像学证据，而25例患者无肺气肿。
肺气肿程度随COPD严重程度增加而增加，大多数COPD患者有肺气肿。因此，肺气肿导致的组织破坏是COPD疾病严重程度的重要决定因素。
