Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Chest. 2013 Nov;144(5):1578-1586. doi: 10.1378/chest.12-2826.
Advanced heterogeneous emphysema with hyperinflation impacts exercise tolerance in COPD. Bronchoscopic lung volume reduction using Zephyr endobronchial valves (EBVs) has been shown to improve lung function in patients with heterogeneous emphysema. It is unclear whether the target lobe perfusion of patients receiving EBV therapy impacts exercise tolerance as measured by the 6-min walk test distance (6MWTD).
We performed a retrospective analysis on the treatment group of the Endobronchial Valve for Emphysema Palliation Trial (VENT) to evaluate the impact of perfusion, measured by 99mTc-MAA-perfusion scintigraphy, on the 6-month improvement in 6MWTD. A mixed-model analysis was performed for the treatment outcome, adjusting for other variables such as age, target lobe position, fissure integrity, BMI, sex, destruction score, and lobar exclusion.
Dichotomized at the median, of the 169 patients who received EBV therapy, 88 had a low target lobe regional perfusion and 81 had high target lobe regional perfusion at baseline. Patients with a low target lobe regional perfusion had a significant improvement in 6MWTD when compared with those with a high baseline target lobe regional perfusion (30.24 m vs 3.72 m, P = .03). Shifts in perfusion after EBV therapy occurred only in patients with high baseline perfusion and did not correlate with improved 6MWTD.
Patients having heterogeneous emphysema with a low baseline target lobe regional perfusion benefit from EBV therapy, independent of the degree of target lobe destruction. This effect is attenuated if the EBV therapy is not occlusive. Characterization of baseline perfusion may enhance clinical results of patients with emphysema undergoing EBV therapy.
ClinicalTrials.gov; No.: NCT00000606; URL: www.clincialtrials.gov.
伴有过度充气的晚期不均匀性肺气肿会影响 COPD 患者的运动耐量。支气管镜下肺减容术使用 Zephyr 支气管内活瓣（EBV）已被证明可改善不均匀性肺气肿患者的肺功能。目前尚不清楚接受 EBV 治疗的患者的目标肺叶灌注是否会影响 6 分钟步行试验距离（6MWTD）所测量的运动耐量。
我们对支气管内活瓣肺气肿缓解试验（VENT）的治疗组进行了回顾性分析，以评估灌注（通过 99mTc-MAA 灌注闪烁显像术测量）对 6 个月时 6MWTD 改善的影响。采用混合模型分析处理治疗结果，同时调整年龄、目标肺叶位置、裂隙完整性、BMI、性别、破坏评分和肺叶切除等其他变量。
在接受 EBV 治疗的 169 例患者中，根据中位数将其分为低目标肺叶区域灌注组（88 例）和高目标肺叶区域灌注组（81 例）。与基线时高目标肺叶区域灌注的患者相比，低目标肺叶区域灌注的患者的 6MWTD 有显著改善（30.24m 比 3.72m，P =.03）。仅在基线灌注较高的患者中观察到 EBV 治疗后的灌注转移，并且与 6MWTD 的改善无关。
与目标肺叶破坏程度无关，基线时低目标肺叶区域灌注的不均匀性肺气肿患者可从 EBV 治疗中获益。如果 EBV 治疗不是闭塞性的，则该效果会减弱。基线灌注的特征描述可能会增强接受 EBV 治疗的肺气肿患者的临床效果。
ClinicalTrials.gov；编号：NCT00000606；网址：www.clincialtrials.gov。
