Pneumology and Critical CareMedicine, Thoraxklinik, Amalienstrasse 5D, Heidelberg, Germany.
Eur Respir J. 2013 Feb;41(2):302-8. doi: 10.1183/09031936.00015312. Epub 2012 May 3.
One-way endobronchial valves (EBVs) have been shown to relieve symptoms of emphysema, particularly in patients without collateral ventilation (CV) between the target and adjacent lobes. In this study, we investigated the ability of the bronchoscopic Chartis™ Pulmonary Assessment System to predict treatment response by determining the presence of CV. 80 EBV patients underwent a pre-treatment Chartis assessment. Before and 30 days after implantation, high-resolution computed tomography scans were taken to determine target lobe volume reduction (TLVR). A pre- to post-treatment reduction of ≥350 mL was defined as significant. In addition, clinical outcomes (forced expiratory volume in 1 s (FEV(1)), 6-min walk test and St George's Respiratory Questionnaire) were compared over the same time period. Of the 51 patients classified as having an absence of CV according to their Chartis reading, 36 showed a TLVR ≥350 mL. 29 patients were classified as having CV, and of these 24 did not meet this TLVR cut-off. Chartis showed an accuracy level of 75% in predicting whether or not the TLVR cut-off would be reached. Those predicted to respond showed significantly greater TLVR (p<0.0001) and FEV(1) improvement (p=0.0013) than those predicted not to respond. Chartis is a safe and effective method of predicting response to EBV treatment.
单向支气管内活瓣（EBV）已被证明可缓解肺气肿症状，尤其是在目标和相邻肺叶之间无侧支通气（CV）的患者中。在这项研究中，我们通过确定 CV 的存在，研究了支气管镜 Chartis™ 肺部评估系统预测治疗反应的能力。80 例 EBV 患者接受了治疗前的 Chartis 评估。在植入前后，进行高分辨率计算机断层扫描以确定目标肺叶体积减少（TLVR）。将治疗前至治疗后的减少量≥350 毫升定义为显著。此外，还在同一时间段内比较了临床结果（1 秒用力呼气量（FEV（1））、6 分钟步行试验和圣乔治呼吸问卷）。根据 Chartis 读数，51 名患者被归类为无 CV，其中 36 名患者的 TLVR≥350 毫升。29 名患者被归类为有 CV，其中 24 名未达到该 TLVR 截止值。Chartis 预测 TLVR 是否达到截止值的准确率为 75%。那些预计会有反应的患者的 TLVR 显著更高（p<0.0001），FEV（1）改善（p=0.0013）也显著高于预计无反应的患者。Chartis 是一种安全有效的预测 EBV 治疗反应的方法。
