Robarts Research Institute, The University of Western Ontario, London, ON, Canada.
Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada.
Eur Respir J. 2016 Aug;48(2):370-9. doi: 10.1183/13993003.00393-2016. Epub 2016 May 12.
In asthma patients, magnetic resonance imaging (MRI) and the lung clearance index (LCI) have revealed persistent ventilation heterogeneity, although its relationship to asthma control is not well understood. Therefore, our goal was to explore the relationship of MRI ventilation defects and the LCI with asthma control and quality of life in patients with severe, poorly controlled asthma.18 patients with severe, poorly controlled asthma (mean±sd 46±12 years, six males/12 females) provided written informed consent to an ethics board approved protocol, and underwent spirometry, LCI and (3)He MRI during a single 2-h visit. Asthma control and quality of life were evaluated using the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Ventilation heterogeneity was quantified using the LCI and (3)He MRI ventilation defect percent (VDP).All participants reported poorly controlled disease (mean±sd ACQ score=2.3±0.9) and highly heterogeneous ventilation (mean±sd VDP=12±11% and LCI=10.5±3.0). While VDP and LCI were strongly correlated (r=0.86, p<0.0001), in a multivariate model that included forced expiratory volume in 1 s, VDP and LCI, VDP was the only independent predictor of asthma control (R(2)=0.38, p=0.01). There was also a significantly worse VDP, but not LCI in asthma patients with an ACQ score >2 (p=0.04) and AQLQ score <5 (p=0.04), and a trend towards worse VDP (p=0.053), but not LCI in asthma patients reporting ≥1 exacerbation in the past 6 months.In patients with poorly controlled, severe asthma MRI ventilation, but not LCI was significantly worse in those with worse ACQ and AQLQ.
在哮喘患者中，磁共振成像（MRI）和肺清除指数（LCI）显示出持续的通气异质性，尽管其与哮喘控制的关系尚不清楚。因此，我们的目标是探讨 MRI 通气缺陷和 LCI 与严重、控制不佳的哮喘患者的哮喘控制和生活质量之间的关系。18 名严重、控制不佳的哮喘患者（平均年龄±标准差 46±12 岁，6 名男性/12 名女性）书面同意参与一项经伦理委员会批准的方案，并在单次 2 小时就诊期间进行了肺活量测定、LCI 和（3）He MRI。使用哮喘控制问卷（ACQ）和哮喘生活质量问卷（AQLQ）评估哮喘控制和生活质量。使用 LCI 和（3）He MRI 通气缺陷百分比（VDP）量化通气异质性。所有参与者均报告疾病控制不佳（平均±标准差 ACQ 评分=2.3±0.9）和高度通气异质性（平均±标准差 VDP=12±11%和 LCI=10.5±3.0）。虽然 VDP 和 LCI 呈强相关性（r=0.86，p<0.0001），但在一个包含用力呼气量 1 秒、VDP 和 LCI 的多元模型中，VDP 是哮喘控制的唯一独立预测因子（R（2）=0.38，p=0.01）。在 ACQ 评分>2 的哮喘患者中，VDP 显著更差，但 LCI 无差异（p=0.04），在 AQLQ 评分<5 的哮喘患者中，VDP 也显著更差，但 LCI 无差异（p=0.04），并且在过去 6 个月中有≥1 次加重史的哮喘患者中，VDP 也有更差的趋势，但 LCI 无差异（p=0.053）。在控制不佳的严重哮喘患者中，MRI 通气，但不是 LCI，在 ACQ 和 AQLQ 较差的患者中明显更差。
