Ronkainen Eveliina, Perhomaa Marja, Mattila Lauri, Hallman Mikko, Dunder Teija
PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Neonatology. 2018;113(2):122-130. doi: 10.1159/000481356. Epub 2017 Nov 24.
A new pattern of bronchopulmonary dysplasia (BPD) has emerged with the improved survival of preterm children.
Our aim was to characterize structural abnormalities associated with new BPD and to evaluate whether the severity of high-resolution computed tomography (HRCT) changes is associated with lung function.
HRCT scans were performed on 21 schoolchildren with a history of new BPD (mild, n = 9; moderate, n = 4; and severe, n = 8) with a mean age of 12.7 years (range: 8.7-16.7). Scans were interpreted by 2 radiologists using a structured scoring system. Spirometry (forced expiratory volume in 1 s [FEV1] and maximum mid-expiratory flow [MMEF]) and the diffusion capacity of the lung for carbon monoxide (DLCO) were measured.
At least 1 HRCT abnormality was evident in 17 children (81%), including linear-to-triangular subpleural opacities (71%), air trapping (29%), mosaic perfusion (24%), peribronchial thickening (14%), and emphysema (14%). The HRCT score was higher in the severe BPD group (11.50; 95% CI 2.86-20.14) than in the mild or moderate BPD group (1.39; 95% CI 0.24-2.54, and 2.75; 95% CI 0.28-5.22, respectively). HRCT scores were inversely related to FEV1 (β -4.23; 95% CI -6.97 to -1.49, p = 0.004) and MMEF (β -3.45; 95% CI -6.10 to -0.80, p = 0.013) but not to DLCO. The duration of the initial mechanical ventilation was associated with HRCT scores (p = 0.014).
Structural lung abnormalities are common among schoolchildren with a history of new BPD, resembling abnormalities described in the presurfactant era. HRCT abnormalities are associated with the duration of early mechanical ventilation and the severity of BPD and they are correlated with spirometry.
随着早产儿存活率的提高，一种新的支气管肺发育不良（BPD）模式出现了。
我们的目的是描述与新BPD相关的结构异常，并评估高分辨率计算机断层扫描（HRCT）改变的严重程度是否与肺功能相关。
对21名有新BPD病史的学龄儿童进行了HRCT扫描（轻度，n = 9；中度，n = 4；重度，n = 8），平均年龄12.7岁（范围：8.7 - 16.7岁）。由2名放射科医生使用结构化评分系统对扫描结果进行解读。测量了肺活量（第1秒用力呼气量[FEV1]和最大呼气中期流速[MMEF]）以及肺一氧化碳弥散量（DLCO）。
17名儿童（81%）至少有1项HRCT异常，包括线性至三角形胸膜下混浊（71%）、气体潴留（29%）、马赛克灌注（24%）、支气管周围增厚（14%）和肺气肿（14%）。重度BPD组的HRCT评分（11.50；95%CI 2.86 - 20.14）高于轻度或中度BPD组（分别为1.39；95%CI 0.24 - 2.54和2.75；95%CI 0.28 - 5.22）。HRCT评分与FEV1（β -4.23；95%CI -6.97至 -1.49，p = 0.004）和MMEF（β -3.45；95%CI -6.10至 -0.80，p = 0.013）呈负相关，但与DLCO无关。初始机械通气的持续时间与HRCT评分相关（p = 0.014）。
有新BPD病史的学龄儿童中肺部结构异常很常见，类似于表面活性剂应用前时代描述的异常。HRCT异常与早期机械通气的持续时间和BPD的严重程度相关，并且与肺活量测定相关。
