Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2011 Dec;26(12):1606-12. doi: 10.3346/jkms.2011.26.12.1606. Epub 2011 Nov 29.
To date, clinico-physiologic indices have not been compared with quantitative CT imaging indices in determining the risk of chronic obstructive pulmonary disease (COPD) exacerbation. We therefore compared clinico-physiologic and CT imaging indices as risk factors for COPD exacerbation in patients with COPD. We retrospectively analyzed 260 COPD patients from pulmonary clinics at 11 hospitals in Korea from June 2005 to November 2009 and followed-up for at least one year. At the time of enrollment, none of these patients had COPD exacerbations for at least 2 months. All underwent clinico-physiologic and radiological evaluation for risk factors of COPD exacerbation. After 1 yr, 106 of the 260 patients had at least one exacerbation of COPD. Multiple logistic regression analysis showed that old age, high Charlson Index, and low FEV(1) were significant in a clinico-physiologic model, with C-statistics of 0.69, and that increased age and emphysema index were significant in a radiologic model, with C-statistics of 0.64. The difference between the two models was statistically significant (P = 0.04 by bootstrap analysis). Combinations of clinico-physiologic risk factors may be better than those of imaging risk factors in predicting COPD exacerbation.
迄今为止，尚没有临床生理指标与定量 CT 成像指标在预测慢性阻塞性肺疾病（COPD）恶化风险方面进行比较。因此，我们比较了 COPD 患者的临床生理和 CT 成像指标作为 COPD 恶化的危险因素。我们回顾性分析了 2005 年 6 月至 2009 年 11 月在韩国 11 家医院的呼吸科诊所就诊的 260 例 COPD 患者，并对其进行了至少 1 年的随访。在入组时，这些患者均至少有 2 个月无 COPD 恶化。所有患者均接受了临床生理和影像学评估，以评估 COPD 恶化的危险因素。1 年后，260 例患者中有 106 例至少发生了 1 次 COPD 恶化。多因素逻辑回归分析显示，在临床生理模型中，高龄、高 Charlson 指数和低 FEV1 是显著的，C 统计量为 0.69，而在影像学模型中，年龄增加和肺气肿指数是显著的，C 统计量为 0.64。两个模型之间的差异具有统计学意义（bootstrap 分析 P = 0.04）。临床生理危险因素的组合可能优于影像学危险因素，能够更好地预测 COPD 恶化。
