慢性阻塞性肺疾病患者基于定量计算机断层扫描的呼吸阻抗多样性
Diversity of respiratory impedance based on quantitative computed tomography in patients with COPD.
作者信息
Wada Yosuke, Kitaguchi Yoshiaki, Yasuo Masanori, Ueno Fumika, Kawakami Satoshi, Fukushima Kiyoyasu, Fujimoto Keisaku, Hanaoka Masayuki
机构信息
First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Department of Radiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
出版信息
Int J Chron Obstruct Pulmon Dis. 2018 Jun 5;13:1841-1849. doi: 10.2147/COPD.S163129. eCollection 2018.
INTRODUCTION
This study was conducted in order to investigate the diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative computed tomography (CT) in patients with COPD.
PATIENTS AND METHODS
Medical records of 174 stable COPD patients were retrospectively reviewed to obtain the patients' clinical data, including the pulmonary function and imaging data. According to the software-based quantification of the degree of emphysema and airway wall thickness, the patients were classified into the "normal by CT" phenotype, the airway-dominant phenotype, the emphysema-dominant phenotype, and the mixed phenotype. The pulmonary function, including the respiratory impedance evaluated by using the forced oscillation technique (FOT) and the reversibility of airway obstruction in response to inhaled short-acting β-agonists, was then compared among the four phenotypes.
RESULTS
The respiratory system resistance at 5 and 20 Hz (R5 and R20) was significantly higher, and the respiratory system reactance at 5 Hz (X5) was significantly more negative in the airway-dominant and mixed phenotypes than in the other phenotypes. The within-breath changes of X5 (ΔX5) were significantly greater in the mixed phenotype than in the "normal by CT" and emphysema-dominant phenotypes. The FOT parameters (R5, R20, and X5) were significantly correlated with indices of the degree of airway wall thickness and significantly but weakly correlated with the reversibility of airway obstruction. There was no significant correlation between the FOT parameters (R5, R20, and X5) and the degree of emphysema.
CONCLUSION
There is a diversity of respiratory physiology, including the respiratory impedance and reversibility of airway obstruction, based on quantitative CT in patients with COPD. The FOT measurements may reflect the degree of airway disease and aid in detecting airway remodeling in patients with COPD.
引言
本研究旨在基于定量计算机断层扫描（CT），调查慢性阻塞性肺疾病（COPD）患者的呼吸生理多样性，包括呼吸阻抗和气道阻塞的可逆性。
患者与方法
回顾性分析174例稳定期COPD患者的病历，以获取患者的临床资料，包括肺功能和影像数据。根据基于软件的肺气肿程度和气道壁厚度量化结果，将患者分为“CT正常”表型、气道为主型表型、肺气肿为主型表型和混合型表型。然后比较这四种表型的肺功能，包括使用强迫振荡技术（FOT）评估的呼吸阻抗以及吸入短效β受体激动剂后气道阻塞的可逆性。
结果
气道为主型和混合型表型在5 Hz和20 Hz时的呼吸系统阻力（R5和R20）显著更高，在5 Hz时的呼吸系统电抗（X5）显著更负。混合型表型的X5呼吸内变化（ΔX5）显著大于“CT正常”和肺气肿为主型表型。FOT参数（R5、R20和X5）与气道壁厚度程度指标显著相关，与气道阻塞的可逆性显著但弱相关。FOT参数（R5、R20和X5）与肺气肿程度之间无显著相关性。
结论
基于定量CT，COPD患者存在呼吸生理多样性，包括呼吸阻抗和气道阻塞的可逆性。FOT测量可能反映气道疾病程度，并有助于检测COPD患者的气道重塑。
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