From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (S.Y.A., A.A.D., F.N.R., R.K.P., G.M.H., I.O.R., G.R.W.), Laboratory of Mathematics in Imaging, Department of Radiology (R.H., J.C.R., G.V.S., J.O.O., R.S.J.E.), and Department of Radiology (H.H.), Brigham and Women's Hospital, 75 Francis St, PBB CA-3, Boston, MA 02115; Department of Medicine, Weil Cornell Medical College, New York, NY (F.J.M., A.M.C.); Departments of Medicine (R.P.B.) and Radiology (D.A.L.), National Jewish Health, Denver, Colo; and Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala (S.P.B., M.T.D., J.M.W.).
Radiology. 2018 Aug;288(2):600-609. doi: 10.1148/radiol.2018172688. Epub 2018 Jun 5.
Purpose To determine if interstitial features at chest CT enhance the effect of emphysema on clinical disease severity in smokers without clinical pulmonary fibrosis. Materials and Methods In this retrospective cohort study, an objective CT analysis tool was used to measure interstitial features (reticular changes, honeycombing, centrilobular nodules, linear scar, nodular changes, subpleural lines, and ground-glass opacities) and emphysema in 8266 participants in a study of chronic obstructive pulmonary disease (COPD) called COPDGene (recruited between October 2006 and January 2011). Additive differences in patients with emphysema with interstitial features and in those without interstitial features were analyzed by using t tests, multivariable linear regression, and Kaplan-Meier analysis. Multivariable linear and Cox regression were used to determine if interstitial features modified the effect of continuously measured emphysema on clinical measures of disease severity and mortality. Results Compared with individuals with emphysema alone, those with emphysema and interstitial features had a higher percentage predicted forced expiratory volume in 1 second (absolute difference, 6.4%; P < .001), a lower percentage predicted diffusing capacity of lung for carbon monoxide (DLCO) (absolute difference, 7.4%; P = .034), a 0.019 higher right ventricular-to-left ventricular (RVLV) volume ratio (P = .029), a 43.2-m shorter 6-minute walk distance (6MWD) (P < .001), a 5.9-point higher St George's Respiratory Questionnaire (SGRQ) score (P < .001), and 82% higher mortality (P < .001). In addition, interstitial features modified the effect of emphysema on percentage predicted DLCO, RVLV volume ratio, 6WMD, SGRQ score, and mortality (P for interaction < .05 for all). Conclusion In smokers, the combined presence of interstitial features and emphysema was associated with worse clinical disease severity and higher mortality than was emphysema alone. In addition, interstitial features enhanced the deleterious effects of emphysema on clinical disease severity and mortality.
在不伴有临床肺纤维化的吸烟者中，确定 CT 肺间质特征是否增强肺气肿对临床疾病严重程度的影响。
在这项回顾性队列研究中，使用一种客观的 CT 分析工具来测量间质性特征（网状改变、蜂窝肺、小叶中心结节、线性瘢痕、结节改变、胸膜下线和磨玻璃影）和慢性阻塞性肺疾病（COPD）研究中 8266 名参与者（COPDGene 研究，招募时间为 2006 年 10 月至 2011 年 1 月）的肺气肿。使用 t 检验、多变量线性回归和 Kaplan-Meier 分析来分析有间质性特征和没有间质性特征的肺气肿患者的附加差异。使用多变量线性和 Cox 回归来确定间质性特征是否改变连续测量的肺气肿对临床疾病严重程度和死亡率的影响。
与单纯肺气肿患者相比，同时存在肺气肿和间质性特征的患者用力肺活量占预计值的百分比（绝对差异，6.4%；P<0.001）更低，一氧化碳弥散量占预计值的百分比（绝对差异，7.4%；P=0.034）更低，右心室与左心室（RVLV）容积比（绝对差异，0.019；P=0.029）更高，6 分钟步行距离（6MWD）（绝对差异，43.2m；P<0.001）更短，圣乔治呼吸问卷（SGRQ）评分（绝对差异，5.9 分；P<0.001）更高，死亡率（绝对差异，82%；P<0.001）更高。此外，间质性特征改变了肺气肿对一氧化碳弥散量占预计值的百分比、RVLV 容积比、6MWD、SGRQ 评分和死亡率的影响（交互作用 P 值<0.05）。
在吸烟者中，间质性特征与肺气肿共存与单纯肺气肿相比，与更严重的临床疾病严重程度和更高的死亡率相关。此外，间质性特征增强了肺气肿对临床疾病严重程度和死亡率的有害影响。
