Ueda Kazuhiro, Murakami Junichi, Tanaka Toshiki, Yoshida Kumiko, Kobayashi Taiga, Hamano Kimikazu
Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
J Surg Res. 2018 Aug;228:20-26. doi: 10.1016/j.jss.2018.02.016. Epub 2018 Mar 26.
The aim of the present study was to clarify the predictors of the response of patients with resectable lung cancer and untreated airflow obstruction to tiotropium, an antimuscarinic bronchodilator.
Tiotropium was administered to 29 preoperative patients with untreated airflow obstruction. The forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV) were measured before and after the introduction of tiotropium. The response to tiotropium was determined based on the percentage gain in the FEV. The volume of the total lung area (TLV) and the low-attenuation area (LAA) was measured by deep inspiratory computed tomography based on the predefined thresholds for attenuation values.
The introduction of tiotropium resulted in a 15% gain in the FEV (P < 0.001). A univariate regression analysis revealed that the FVC/TLV was the best predictor of the gain in FEV, followed by the FEV/FVC. Based on the results of a multiple regression analysis, a regression equation to predict a gain in the FEV was generated using the FVC, TLV, and LAA. A receiver operating characteristic curve analysis revealed that this equation led to the highest area under the curve for predicting a major response to tiotropium, followed by the FVC/TLV and FEV/FVC. Postoperatively, six of the 20 minor responders experienced a progression of dyspnea. In contrast, none of the major responders experienced a progression of dyspnea (P < 0.05).
We developed an equation for predicting the response to tiotropium using parameters obtained from spirometry and quantitative computed tomography. A large-scale study to validate the usefulness of this equation is warranted.
本研究旨在明确可切除肺癌且未治疗气流阻塞的患者对抗毒蕈碱支气管扩张剂噻托溴铵反应的预测因素。
对29例术前存在未治疗气流阻塞的患者给予噻托溴铵治疗。在给予噻托溴铵前后测量用力肺活量（FVC）和1秒用力呼气量（FEV）。根据FEV的增加百分比确定对噻托溴铵的反应。基于预定义的衰减值阈值，通过深吸气计算机断层扫描测量全肺面积（TLV）和低衰减面积（LAA）。
给予噻托溴铵后FEV增加了15%（P < 0.001）。单因素回归分析显示，FVC/TLV是FEV增加的最佳预测因素，其次是FEV/FVC。基于多因素回归分析的结果，使用FVC、TLV和LAA生成了一个预测FEV增加的回归方程。受试者工作特征曲线分析显示，该方程在预测对噻托溴铵的主要反应方面导致曲线下面积最大，其次是FVC/TLV和FEV/FVC。术后，20例轻度反应者中有6例出现呼吸困难进展。相比之下，主要反应者中无一例出现呼吸困难进展（P < 0.05）。
我们使用肺活量测定和定量计算机断层扫描获得的参数开发了一个预测对噻托溴铵反应的方程。有必要进行大规模研究来验证该方程的实用性。
