Kang In Sook, Kim Kyung Jin, Kim Yookyung, Park Seong-Hoon
Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2014 Nov;29(6):746-53. doi: 10.3904/kjim.2014.29.6.746. Epub 2014 Oct 31.
BACKGROUND/AIMS: Amiodarone is one of the most widely used antiarrhythmic agents; however, amiodarone-induced pulmonary toxicity (APT) can be irreversible and sometimes fatal. The aim of this study was to evaluate the feasibility of chest computed tomography (CT) as a diagnostic tool for APT and to assess the utility of the CT APT score as an index for predicting the severity of APT.
Patients underwent amiodarone treatment for various reasons, most often atrial fibrillation, for more than 2 years, and those that received a cumulative dose > 100 g were enrolled. A total of 34 patients who underwent chest CT between December 2011 and June 2012 were enrolled, whether or not they had clinical symptoms. The APT CT score was defined as the number of involved regions in the lung, which was divided into 18 regions (right and left, upper, middle, and lower, and central, middle, and peripheral). The CT findings were evaluated according to the total dose and duration of amiodarone treatment and the results of a pulmonary function test. Clinical symptoms and outcomes were also evaluated according to APT CT scores.
Seven patients had positive APT CT scores (interstitial fibrosis in five, organizing pneumonia in one, and mixed interstitial fibrosis and organizing pneumonia in one), and these patients exhibited significantly lower diffusion capacity for carbon monoxide in the lungs compared with patients without an increased APT CT score (70.2% ± 6.9% vs. 89.7% ± 19.4%; p = 0.011). Three of the seven patients experienced overt APT that required hospital admission.
Chest CT is a useful diagnostic tool for APT, and the APT CT score might be a useful index for assessing the severity of APT.
背景/目的：胺碘酮是应用最广泛的抗心律失常药物之一；然而，胺碘酮所致肺毒性（APT）可能不可逆转，有时甚至会致命。本研究的目的是评估胸部计算机断层扫描（CT）作为APT诊断工具的可行性，并评估CT APT评分作为预测APT严重程度指标的效用。
因各种原因接受胺碘酮治疗（最常见的是心房颤动）超过2年且累积剂量>100 g的患者纳入研究。2011年12月至2012年6月期间接受胸部CT检查的34例患者纳入研究，无论其是否有临床症状。APT CT评分定义为肺部受累区域的数量，肺部被分为18个区域（左右、上、中、下以及中央、中间和外周）。根据胺碘酮治疗的总剂量、持续时间以及肺功能测试结果评估CT表现。还根据APT CT评分评估临床症状和结局。
7例患者APT CT评分呈阳性（5例为间质性纤维化，1例为机化性肺炎，1例为间质性纤维化和机化性肺炎混合），与APT CT评分未升高的患者相比，这些患者的肺一氧化碳弥散能力显著降低（70.2%±6.9%对89.7%±19.4%；p = 0.011）。7例患者中有3例发生明显的APT，需要住院治疗。
胸部CT是APT的一种有用诊断工具，APT CT评分可能是评估APT严重程度的有用指标。
