慢性阻塞性肺疾病患者容积 CT 扫描评估的气道直径变化与肺气肿与充气的相关性。
Association between airway caliber changes with lung inflation and emphysema assessed by volumetric CT scan in subjects with COPD.
机构信息
Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Pulmonary Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile.
Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Chest. 2012 Mar;141(3):736-744. doi: 10.1378/chest.11-1026. Epub 2011 Sep 22.
BACKGROUND
An increase in airway caliber (airway distensibility) with lung inflation is attenuated in COPD. Furthermore, some subjects have a decrease in airway caliber with lung inflation. We aimed to test the hypothesis that airway caliber increases are lower in subjects with emphysema-predominant (EP) compared with airway-predominant (AP) CT scan subtypes. Additionally, we compared clinical and CT scan features of subjects with (airway constrictors) and without a decrease in airway caliber.
METHODS
Based on GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages and CT scan subtypes, we created a control group (n = 46) and the following matched COPD groups (n = 23 each): GOLD-2-AP, GOLD-2-EP, GOLD-4-AP, and GOLD-4-EP. From the CT scans of all 138 subjects, we measured emphysema, lung volumes, and caliber changes in the third and fourth airway generations of two bronchi. We expressed airway distensibility (ratio of airway lumen diameter change to lung volume change from end tidal breathing to full inspiration) as a global or lobar measure based on normalization by whole-lung or lobar volume changes.
RESULTS
Global distensibility in the third and fourth airway generations was significantly lower in the GOLD-2-EP and GOLD-4-EP groups than in control subjects. In GOLD-2 subjects, lobar distensibility of the right-upper-lobe fourth airway generation was significantly lower in those with EP than in those with AP. In multivariate analysis, emphysema was an independent determinant of global and lobar airway distensibility. Compared with nonconstrictors, airway constrictors experienced more dyspnea, were more hyperinflated, and had a higher percentage of emphysema.
CONCLUSIONS
Distensibility of large- to medium-sized airways is reduced in subjects with an EP CT scan subtype. Emphysema seems to alter airway-parenchyma interdependence.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.
背景
在 COPD 患者中，气道口径（气道可扩张性）随肺充气而增加的程度减弱。此外，一些患者的气道口径随肺充气而减小。我们旨在检验以下假说，即与气道为主型（AP）CT 扫描亚型相比，肺气肿为主型（EP）CT 扫描亚型的气道口径增加幅度较低。此外，我们比较了具有（气道缩窄剂）和无气道口径减小的患者的临床和 CT 扫描特征。
方法
根据 GOLD（全球慢性阻塞性肺疾病倡议）分期和 CT 扫描亚型，我们创建了一个对照组（n = 46）和以下匹配的 COPD 组（每组 23 人）：GOLD-2-AP、GOLD-2-EP、GOLD-4-AP 和 GOLD-4-EP。我们从所有 138 名受试者的 CT 扫描中测量了第三和第四气道级别的肺气肿、肺容积和口径变化。我们将气道可扩张性（从潮气呼吸到完全吸气时气道腔直径变化与肺容积变化的比值）表示为基于全肺或肺叶容积变化归一化的整体或叶测量值。
结果
第三和第四气道级别的全球可扩张性在 GOLD-2-EP 和 GOLD-4-EP 组中明显低于对照组。在 GOLD-2 患者中，右肺上叶第四气道级别的叶间可扩张性在 EP 患者中明显低于 AP 患者。在多变量分析中，肺气肿是整体和叶间气道可扩张性的独立决定因素。与非气道缩窄剂相比，气道缩窄剂经历更多的呼吸困难，更加过度充气，并且肺气肿的百分比更高。
结论
具有 EP CT 扫描亚型的患者的大中气道可扩张性降低。肺气肿似乎改变了气道-实质的相互依存关系。
试验注册
ClinicalTrials.gov；编号：NCT00608764；网址：www.clinicaltrials.gov。
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