Alotaibi Nawaf M, Chen Virginia, Hollander Zsuzsanna, Hague Cameron J, Murphy Darra T, Leipsic Jonathon A, DeMarco Mari L, FitzGerald J Mark, McManus Bruce M, Ng Raymond T, Sin Don D
Centre for Heart Lung Innovation, James Hogg Research Centre, St Paul's Hospital, Vancouver, BC, Canada.
Division of Pulmonary Medicine, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Int J Chron Obstruct Pulmon Dis. 2018 Jan 8;13:217-229. doi: 10.2147/COPD.S152484. eCollection 2018.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are caused by a variety of different etiologic agents. Our aim was to phenotype COPD exacerbations using imaging (chest X-ray [CXR] and computed tomography [CT]) and to determine the possible role of the blood tests (C-reactive protein [CRP], the N-terminal prohormone brain natriuretic peptide [NT-proBNP]) as diagnostic biomarkers.
Subjects who were hospitalized with a primary diagnosis of AECOPD and who had had CXRs, CT scans, and blood collection for CRP and NT-proBNP were assessed in this study. Radiologist blinded to the clinical and laboratory characteristics of the subjects interpreted their CXRs and CT images. ANOVA and Spearman's correlation were performed to test for associations between these imaging parameters and the blood-based biomarkers NT-proBNP and CRP; logistic regression models were used to assess the performance of these biomarkers in predicting the radiological parameters.
A total of 309 subjects were examined for this study. Subjects had a mean age of 65.6±11.1 years, 66.7% of them were males, and 62.4% were current smokers, with a mean FEV 54.4%±21.5% of predicted. Blood NT-proBNP concentrations were associated with cardiac enlargement (area under the curve [AUC] =0.72, <0.001), pulmonary edema (AUC =0.63, =0.009), and pleural effusion on CXR (AUC =0.64, =0.01); whereas on CT images, NT-proBNP concentrations were associated with pleural effusion (AUC =0.71, =0.002). Serum CRP concentrations, on the other hand, were associated with consolidation on CT images (AUC =0.75, <0.001), ground glass opacities (AUC =0.64, =0.028), and pleural effusion (AUC =0.72, <0.001) on CT images. A serum CRP sensitivity-oriented cutoff point of 11.5 mg/L was selected for the presence of consolidation on CT images in subjects admitted as cases of AECOPD, which has a sensitivity of 91% and a specificity of 53% (<0.001).
Elevated CRP may indicate the presence of pneumonia, while elevated NT-proBNP may indicate cardiac dysfunction. These readily available blood-based biomarkers may provide more accurate phenotyping of AECOPD and enable the discovery of more precise therapies.
慢性阻塞性肺疾病急性加重（AECOPD）由多种不同病因引起。我们的目的是利用影像学（胸部X线[CXR]和计算机断层扫描[CT]）对COPD加重进行表型分析，并确定血液检查（C反应蛋白[CRP]、N末端脑钠肽前体[NT-proBNP]）作为诊断生物标志物的可能作用。
本研究评估了以AECOPD为主要诊断住院且进行了CXR、CT扫描以及采集了用于检测CRP和NT-proBNP的血液样本的受试者。对受试者的临床和实验室特征不知情的放射科医生解读他们的CXR和CT图像。进行方差分析和Spearman相关性分析以检验这些影像学参数与血液生物标志物NT-proBNP和CRP之间的关联；使用逻辑回归模型评估这些生物标志物在预测放射学参数方面的表现。
本研究共检查了309名受试者。受试者的平均年龄为65.6±11.1岁，其中66.7%为男性，62.4%为当前吸烟者，平均FEV为预测值的54.4%±21.5%。血液NT-proBNP浓度与心脏扩大（曲线下面积[AUC]=0.72，P<0.001）、肺水肿（AUC =0.63，P =0.009）以及CXR上的胸腔积液（AUC =0.64，P =0.01）相关；而在CT图像上，NT-proBNP浓度与胸腔积液相关（AUC =0.71，P =0.002）。另一方面，血清CRP浓度与CT图像上的实变（AUC =0.75，P<0.001）、磨玻璃影（AUC =0.64，P =0.028）以及CT图像上的胸腔积液（AUC =0.72，P<0.001）相关。对于以AECOPD病例入院的受试者，选择血清CRP以敏感性为导向的截断点为11.5 mg/L用于CT图像上实变的存在，其敏感性为91%，特异性为53%（P<0.001）。
CRP升高可能提示肺炎的存在，而NT-proBNP升高可能提示心脏功能障碍。这些易于获得的血液生物标志物可能为AECOPD提供更准确的表型分析，并有助于发现更精确的治疗方法。
Zotero 插件