Theilig Dorothea, Doellinger Felix, Poellinger Alexander, Schreiter Vera, Neumann Konrad, Hubner Ralf-Harto
Department of Radiology, Charité Campus Virchow Klinikum, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Institute of Biometrics and Clinical Epidemiology, Charité Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Int J Chron Obstruct Pulmon Dis. 2017 Jun 1;12:1631-1640. doi: 10.2147/COPD.S133348. eCollection 2017.
The degree of interlobar emphysema heterogeneity is thought to play an important role in the outcome of endoscopic lung volume reduction (ELVR) therapy of patients with advanced COPD. There are multiple ways one could possibly define interlobar emphysema heterogeneity, and there is no standardized definition.
The aim of this study was to derive a formula for calculating an interlobar emphysema heterogeneity index (HI) when evaluating a patient for ELVR. Furthermore, an attempt was made to identify a threshold for relevant interlobar emphysema heterogeneity with regard to ELVR.
We retrospectively analyzed 50 patients who had undergone technically successful ELVR with placement of one-way valves at our institution and had received lung function tests and computed tomography scans before and after treatment. Predictive accuracy of the different methods for HI calculation was assessed with receiver-operating characteristic curve analysis, assuming a minimum difference in forced expiratory volume in 1 second of 100 mL to indicate a clinically important change.
The HI defined as emphysema score of the targeted lobe (TL) minus emphysema score of the ipsilateral nontargeted lobe disregarding the middle lobe yielded the best predicative accuracy (AUC =0.73, =0.008). The HI defined as emphysema score of the TL minus emphysema score of the lung without the TL showed a similarly good predictive accuracy (AUC =0.72, =0.009). Subgroup analysis suggests that the impact of interlobar emphysema heterogeneity is of greater importance in patients with upper lobe predominant emphysema than in patients with lower lobe predominant emphysema.
This study reveals the most appropriate ways of calculating an interlobar emphysema heterogeneity with regard to ELVR.
叶间肺气肿异质性程度被认为在晚期慢性阻塞性肺疾病（COPD）患者的内镜下肺减容（ELVR）治疗结果中起重要作用。有多种可能定义叶间肺气肿异质性的方法，且尚无标准化定义。
本研究的目的是推导一个在评估患者进行ELVR时计算叶间肺气肿异质性指数（HI）的公式。此外，还试图确定与ELVR相关的叶间肺气肿异质性阈值。
我们回顾性分析了50例在我院接受技术上成功的ELVR并置入单向瓣膜的患者，这些患者在治疗前后均接受了肺功能测试和计算机断层扫描。采用受试者操作特征曲线分析评估不同HI计算方法的预测准确性，假设1秒用力呼气量的最小差异为100 mL以表明具有临床重要变化。
将HI定义为目标肺叶（TL）的肺气肿评分减去同侧非目标肺叶（不包括中叶）的肺气肿评分，其预测准确性最佳（曲线下面积[AUC]=0.73，P=0.008）。将HI定义为TL的肺气肿评分减去无TL肺叶的肺气肿评分，其预测准确性同样良好（AUC=0.72，P=0.009）。亚组分析表明，叶间肺气肿异质性对以肺上叶为主的肺气肿患者的影响比对以肺下叶为主的肺气肿患者更为重要。
本研究揭示了在ELVR方面计算叶间肺气肿异质性的最合适方法。
