慢性阻塞性肺疾病患者常规胸部X光片上肺炎的预测因素：两项为期1年的随机对照试验的事后分析

Predictors of pneumonia on routine chest radiographs in patients with COPD: a post hoc analysis of two 1-year randomized controlled trials.

作者信息

Rubin David B, Ahmad Harris A, O'Neal Michael, Bennett Sophie, Lettis Sally, Galkin Dmitry V, Crim Courtney

机构信息

Respiratory R&D, GSK, Research Triangle Park, NC.

Medical Affairs, Medical Imaging and Biomarkers, BioClinica Inc., Princeton, NJ, USA.

出版信息

Int J Chron Obstruct Pulmon Dis. 2018 Jan 8;13:189-201. doi: 10.2147/COPD.S142530. eCollection 2018.

DOI:10.2147/COPD.S142530

PMID:29386888

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5764287/

Abstract

BACKGROUND

Patients with COPD are at risk for life-threatening pneumonia. Although anatomical abnormalities in the thorax may predispose to pneumonia, those abnormalities identified on routine chest X-rays (CXRs) in patients with COPD have not been studied to better understand pneumonia risk.

METHODS

We conducted a post hoc exploratory analysis of data from two replicate year-long clinical trials assessing the impact of fluticasone furoate-vilanterol versus vilanterol alone on COPD exacerbations (GSK studies: HZC102871/NCT01009463 and HZC102970/NCT01017952). Abnormalities on baseline CXRs from 179 patients who developed pneumonia and 50 randomly selected patients who did not were identified by blinded consensus readings conducted by two radiologists. Positive and negative likelihood ratios and diagnostic odds ratios (ORs) were calculated to evaluate the markers for subsequent pneumonia development during the 1-year study period.

RESULTS

Baseline characteristics distinguishing the pneumonia and non-pneumonia groups included a lower body mass index (24.9 vs 27.5 kg/m, =0.008), more severe airflow obstruction (mean post-bronchodilator forced expiratory volume in 1 second [FEV]/forced vital capacity ratio: 42.3% vs 47.6%, =0.003), and prior pneumonia (36% vs 20%, =0.030). Baseline CXR findings with the highest diagnostic ORs were: elevated hemi-diaphragm (OR: 6.87; 95% CI: 0.90, 52.26), thick tracheal-esophageal stripe (OR: 4.39 [0.25, 78.22]), narrow cardiac silhouette (OR: 2.91 [0.85, 9.99]), calcified pleural plaque/mid-chest pleural thickening (OR: 2.82 [0.15, 53.76]), and large/prominent pulmonary artery shadow (OR: 1.94 [0.95, 3.97]). The presence of a narrow cardiac silhouette at baseline was associated with a statistically significant lower mean pre-bronchodilator FEV (=0.040). There was also a trend for a lower mean pre-bronchodilator FEV in patients with a large/prominent pulmonary artery shadow at baseline (=0.095).

CONCLUSION

Findings on routine CXR that relate to pathophysiological mechanisms of pneumonia could help determine pneumonia risk in patients with COPD.

摘要

背景

慢性阻塞性肺疾病（COPD）患者有发生危及生命的肺炎的风险。虽然胸部的解剖学异常可能易患肺炎，但尚未对COPD患者常规胸部X线（CXR）检查中发现的这些异常进行研究，以更好地了解肺炎风险。

方法

我们对两项为期一年的重复临床试验的数据进行了事后探索性分析，评估糠酸氟替卡松-维兰特罗与单独使用维兰特罗对COPD急性加重的影响（葛兰素史克研究：HZC102871/NCT01009463和HZC102970/NCT01017952）。由两名放射科医生通过盲法共识读数确定了179例发生肺炎的患者和50例随机选择的未发生肺炎的患者基线CXR的异常情况。计算阳性和阴性似然比以及诊断比值比（OR），以评估1年研究期间后续肺炎发生的标志物。

结果

区分肺炎组和非肺炎组的基线特征包括较低的体重指数（24.9 vs 27.5 kg/m²，P=0.008）、更严重的气流阻塞（支气管扩张剂后1秒用力呼气容积[FEV₁]/用力肺活量比值：42.3% vs 47.6%，P=0.003）和既往肺炎史（36% vs 20%，P=0.030）。诊断OR最高的基线CXR表现为：半膈肌抬高（OR：6.87；95%CI：0.90，52.26）、气管食管条纹增厚（OR：4.39[0.25，78.22]）、心脏轮廓变窄（OR：2.91[0.85，9.99]）、钙化性胸膜斑/中胸部胸膜增厚（OR：2.82[0.15，53.76]）和大/突出的肺动脉阴影（OR：1.94[0.95，3.97]）。基线时心脏轮廓变窄与支气管扩张剂前FEV₁均值在统计学上显著降低相关（P=0.040）。基线时有大/突出肺动脉阴影的患者支气管扩张剂前FEV₁均值也有降低趋势（P=0.095）。