慢性阻塞性肺疾病患者三维 CT 气道结构评估与改良医学研究理事会呼吸困难量表的相关性。
Correlation of the modified Medical Research Council dyspnea scale with airway structure assessed by three-dimensional CT in patients with chronic obstructive pulmonary disease.
机构信息
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
出版信息
Respir Med. 2019 Jan;146:76-80. doi: 10.1016/j.rmed.2018.11.020. Epub 2018 Dec 12.
BACKGROUND
Dyspnea is a common symptom in chronic obstructive pulmonary disease (COPD). The modified Medical Research Council (mMRC) dyspnea scale is a widely used questionnaire to assess dyspnea. However, the relationship of the mMRC dyspnea scale with morphological airway structures in COPD remains unclear. We evaluated the correlation between the mMRC dyspnea scale and imaging-based airway structures in patients with COPD.
METHODS
The wall area (WA) and airway inner luminal area (Ai) of third-to sixth-generation bronchi and the percentage of low attenuation area with less than -950 HU (%LAA) of the lungs were measured using three-dimensional computed tomography in patients with COPD. WA and Ai were corrected by body surface area (BSA).
RESULTS
Forty-two clinically stable patients with COPD were enrolled. The median (range) mMRC dyspnea scale was 2 (0-3). The mMRC dyspnea scale score was significantly correlated with WA/BSA of fifth- and sixth-generation bronchi (Spearman correlation coefficient ρ = 0.386, p = 0.012; ρ = 0.484, p = 0.001, respectively). Partial rank correlation analysis showed that the mMRC dyspnea scale score was significantly correlated with WA/BSA of sixth-generation bronchi, independent of the confounding factors of age, body mass index, %predicted forced expiratory volume in 1 s, %LAA, and Ai/BSA (ρ = 0.481, p = 0.003). However, the %LAA and Ai/BSA were not correlated with this dyspnea scale.
CONCLUSION
Bronchial WA assessed by three-dimensional computed tomography may be used as an assessment tool for dyspnea in patients with COPD.
背景
呼吸困难是慢性阻塞性肺疾病（COPD）的常见症状。改良的医学研究理事会（mMRC）呼吸困难量表是一种广泛用于评估呼吸困难的问卷。然而，mMRC 呼吸困难量表与 COPD 患者气道形态结构之间的关系尚不清楚。我们评估了 COPD 患者的 mMRC 呼吸困难量表与基于影像学的气道结构之间的相关性。
方法
使用三维计算机断层扫描测量 COPD 患者第三至第六代支气管的壁面积（WA）和气道内腔面积（Ai）以及肺部低于-950 HU（%LAA）的低衰减区域的百分比。WA 和 Ai 通过体表面积（BSA）进行校正。
结果
共纳入 42 例临床稳定的 COPD 患者。mMRC 呼吸困难量表的中位数（范围）为 2（0-3）。mMRC 呼吸困难量表评分与第五和第六代支气管的 WA/BSA 呈显著相关（Spearman 相关系数 ρ=0.386，p=0.012；ρ=0.484，p=0.001）。偏相关分析表明，mMRC 呼吸困难量表评分与第六代支气管的 WA/BSA 呈显著相关，独立于年龄、体重指数、预测 1 秒用力呼气量的百分比、%LAA 和 Ai/BSA 的混杂因素（ρ=0.481，p=0.003）。然而，%LAA 和 Ai/BSA 与该呼吸困难量表无关。
结论
三维计算机断层扫描评估的支气管 WA 可用作 COPD 患者呼吸困难的评估工具。
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