Oikonomou Anastasia, Mintzopoulou Paraskevi, Tzouvelekis Argyris, Zezos Petros, Zacharis George, Koutsopoulos Anastasios, Bouros Demosthenes, Prassopoulos Panos
Anastasia Oikonomou, Paraskevi Mintzopoulou, Panos Prassopoulos, Department of Radiology, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece.
World J Radiol. 2015 Sep 28;7(9):294-305. doi: 10.4329/wjr.v7.i9.294.
To investigate whether the predominant emphysema type is associated with the high resolution computed tomography (HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema (CPFE).
Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on - HRCT - were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular (CLE), paraseptal (PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia (UIP), probable UIP and nonspecific interstitial pneumonia (NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis (Coarseness), extent of emphysema (emphysema), extent of interstitial lung disease (TotExtILD), extent of reticular pattern not otherwise specified (RetNOS), extent of ground glass opacity with traction bronchiectasis (extGGOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity (DLCO) and systolic pulmonary arterial pressure were compared among the groups.
The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema (P < 0.001) and a lower extent of interstitial lung disease (P < 0.002), reticular pattern not otherwise specified (P < 0.023), extent of ground glass opacity with traction bronchiectasis (P < 0.002), extent of honeycombing (P < 0.001) and coarseness of fibrosis (P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema (P < 0.05), total lung capacity (P < 0.01) and diffusion capacity (DLCO) (P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis (0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.
In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.
探讨在合并肺纤维化和肺气肿（CPFE）中，主要的肺气肿类型是否与高分辨率计算机断层扫描（HRCT）的纤维化模式相关。
对53例HRCT显示上叶肺气肿和下叶肺纤维化的吸烟者进行回顾性评估。根据主要的肺气肿类型，患者被分为3组：小叶中心型（CLE）、间隔旁型（PSE）、CLE = PSE。根据HRCT上主要的纤维化类型，患者还被分为另外3组：典型的普通间质性肺炎（UIP）、可能的UIP和非特异性间质性肺炎（NSIP）。对HRCT在5个预定水平进行评分，包括纤维化的粗糙度（粗糙度）、肺气肿的范围（肺气肿）、间质性肺疾病的范围（TotExtILD）、未另作说明的网状模式的范围（RetNOS）、伴有牵拉性支气管扩张的磨玻璃影的范围（extGGOBx）、单纯磨玻璃影的范围和蜂窝状改变的范围。比较各组的HRCT平均评分、肺功能测试、弥散能力（DLCO）和收缩期肺动脉压。
主要的肺气肿类型与主要的纤维化类型密切相关。小叶中心型肺气肿组的肺气肿范围显著更高（P < 0.001），间质性肺疾病范围、未另作说明的网状模式范围、伴有牵拉性支气管扩张的磨玻璃影范围、蜂窝状改变范围和纤维化粗糙度均显著低于间隔旁型组（P < 0.002、P < 0.023、P < 0.002、P < 0.001、P < 0.001）。NSIP组的肺气肿范围、肺总量（P < 0.01）和弥散能力（DLCO）（P < 0.05）显著高于典型UIP组。典型UIP组的间质性肺疾病范围、未另作说明的网状模式范围、伴有牵拉性支气管扩张的磨玻璃影范围、蜂窝状改变范围和纤维化粗糙度均显著更高（0.039 > P > 0.000）。尽管典型UIP组的肺动脉压相对于NSIP组更高，但差异无统计学意义。
在CPFE患者中，间隔旁型肺气肿比小叶中心型肺气肿更易与UIP - HRCT模式及更高程度的纤维化相关。
