Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Korean J Radiol. 2019 Feb;20(2):304-312. doi: 10.3348/kjr.2018.0204.
To determine the predictive factors for treatment responsiveness in patients with chronic obstructive pulmonary disease (COPD) at 1-year follow-up by performing quantitative analyses of baseline CT scans.
COPD patients (n = 226; 212 men, 14 women) were recruited from the Korean Obstructive Lung Disease cohort. Patients received a combination of inhaled long-acting beta-agonists and corticosteroids twice daily for 3 months and subsequently received medications according to the practicing clinician's decision. The emphysema index, air-trapping indices, and airway parameter (Pi10), calculated using both full-width-half-maximum and integral-based half-band (IBHB) methods, were obtained with baseline CT scans. Clinically meaningful treatment response was defined as an absolute increase of ≥ 0.225 L in the forced expiratory volume in 1 second (FEV₁) at the one-year follow-up. Multivariate logistic regression analysis was performed to investigate the predictors of an increase in FEV₁, and receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the suggested models.
Treatment response was noted in 47 patients (20.8%). The mean FEV₁ increase in responders was 0.36 ± 0.10 L. On univariate analysis, the air-trapping index (ATI) obtained by the subtraction method, ATI of the emphysematous area, and IBHB-measured Pi10 parameter differed significantly between treatment responders and non-responders ( = 0.048, 0.042, and 0.002, respectively). Multivariate analysis revealed that the IBHB-measured Pi10 was the only independent variable predictive of an FEV₁ increase ( = 0.003). The adjusted odds ratio was 1.787 (95% confidence interval: 1.220-2.619). The area under the ROC curve was 0.641.
Measurement of standardized airway dimensions on baseline CT by using a recently validated quantification method can predict treatment responsiveness in COPD patients.
通过对基线 CT 扫描进行定量分析，确定慢性阻塞性肺疾病（COPD）患者在 1 年随访时治疗反应的预测因素。
从韩国阻塞性肺疾病队列中招募了 226 名 COPD 患者（212 名男性，14 名女性）。患者接受了为期 3 个月的每日两次吸入长效β激动剂和皮质激素治疗，随后根据临床医生的决定接受药物治疗。使用全宽半高最大值和积分半带宽（IBHB）方法获得了基线 CT 扫描的肺气肿指数、空气潴留指数和气道参数（Pi10）。临床有意义的治疗反应定义为在 1 年随访时用力呼气量（FEV₁）绝对值增加≥0.225 L。进行了多变量逻辑回归分析，以研究 FEV₁增加的预测因素，并进行了受试者工作特征（ROC）分析，以评估建议模型的性能。
在 47 名患者（20.8%）中观察到治疗反应。应答者的平均 FEV₁增加量为 0.36±0.10 L。在单变量分析中，通过减法法获得的空气潴留指数（ATI）、肺气肿区域的 ATI 和 IBHB 测量的 Pi10 参数在治疗应答者和非应答者之间差异有统计学意义（=0.048、0.042 和 0.002）。多变量分析显示，IBHB 测量的 Pi10 是唯一预测 FEV₁增加的独立变量（=0.003）。调整后的优势比为 1.787（95%置信区间：1.220-2.619）。ROC 曲线下面积为 0.641。
使用最近验证的量化方法对基线 CT 进行标准化气道尺寸测量可以预测 COPD 患者的治疗反应。
Zotero 插件
