Bozzetti Francesca, Paladini Ilaria, Rabaiotti Enrico, Franceschini Alessandro, Alfieri Veronica, Chetta Alfredo, Crisafulli Ernesto, Silva Mario, Pastorino Ugo, Sverzellati Nicola
Section of Radiology, Department of Surgical Sciences, University of Parma, Parma, Italy.
Department of Radiology, Academic Hospital of Parma, Parma, Italy.
Int J Chron Obstruct Pulmon Dis. 2016 May 26;11:1087-96. doi: 10.2147/COPD.S103256. eCollection 2016.
In this study, we tested the association between COPD and interstitial lung abnormality (ILA), notably in relation to the presence of computed tomography (CT) signs of lung fibrosis.
COPD cases were selected from participants undergoing lung cancer screening (Multicentric Italian Lung Detection trial) for airflow obstruction (n=311/2,303, 13.5%) and 146 consecutive patients with clinical COPD. In all, 457 COPD cases were selected and classified according to the stages of Global Initiative for Chronic Obstructive Lung Disease. A nested matching (case:control = 1:2) according to age, sex, and smoking history was operated between each COPD case and two control subjects from Multicentric Italian Lung Detection trial without airflow obstruction. Low-dose CT scans of COPD cases and controls were reviewed for the presence of ILA, which were classified into definite or indeterminate according to the presence of signs of lung fibrosis.
The frequency of definite ILA was similar between COPD cases and controls (P=0.2), independent of the presence of signs of lung fibrosis (P=0.07). Combined definite and indeterminate ILA was homogeneously distributed across Global Initiative for Chronic Obstructive Lung Disease stages (P=0.6). Definite ILA was directly associated with current smoker status (odds ratio [OR] 4.05, 95% confidence interval [CI]: 2.2-7.4) and increasing pack-years (OR 1.01, 95% CI: 1-1.02). Subjects with any fibrotic ILA were more likely to be older (OR 1.17, 95% CI: 1.10-1.25) and male (OR 8.58, 95% CI: 1.58-68.9).
There was no association between COPD and definite ILA. However, low-dose CT signs of lung fibrosis were also observed in COPD, and their clinical relevance is yet to be determined.
在本研究中，我们测试了慢性阻塞性肺疾病（COPD）与间质性肺异常（ILA）之间的关联，特别是与肺纤维化的计算机断层扫描（CT）征象的关系。
COPD病例选自接受肺癌筛查（多中心意大利肺癌检测试验）的参与者中的气流受限者（n = 311/2303，13.5%）以及146例连续的临床COPD患者。总共选取了457例COPD病例，并根据慢性阻塞性肺疾病全球倡议组织的阶段进行分类。在每个COPD病例与多中心意大利肺癌检测试验中无气流受限的两名对照受试者之间，根据年龄、性别和吸烟史进行了巢式匹配（病例：对照 = 1:2）。对COPD病例和对照的低剂量CT扫描进行ILA存在情况的评估，根据肺纤维化征象的存在将其分为明确的或不确定的。
COPD病例和对照中明确ILA的频率相似（P = 0.2），与肺纤维化征象的存在无关（P = 0.07）。明确和不确定的ILA组合在慢性阻塞性肺疾病全球倡议组织各阶段中分布均匀（P = 0.6）。明确的ILA与当前吸烟者状态直接相关（比值比[OR] 4.05，95%置信区间[CI]：2.2 - 7.4）以及吸烟包年数增加相关（OR 1.01，95% CI：1 - 1.02）。有任何纤维化ILA的受试者更可能年龄较大（OR 1.17，95% CI：1.10 - 1.25）且为男性（OR 8.58，95% CI：1.58 - 68.9）。
COPD与明确的ILA之间无关联。然而，在COPD中也观察到了肺纤维化的低剂量CT征象，其临床相关性尚待确定。
