Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Radiology, Berlin, Germany.
Department of Internal Medicine/Infectious and Respiratory Disease, Charité Universitätsmedizin Berlin, Berlin, Germany.
Int J Chron Obstruct Pulmon Dis. 2019 Jul 17;14:1583-1593. doi: 10.2147/COPD.S204007. eCollection 2019.
Quantitative analysis of CT scans has proven to be a reproducible technique, which might help to understand the pathophysiology of chronic obstructive pulmonary disease (COPD) and combined pulmonary fibrosis and emphysema. The aim of this retrospective study was to find out if the lung function of patients with COPD with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV and pulmonary emphysema is measurably influenced by high attenuation areas as a correlate of concomitant unspecific fibrotic changes of lung parenchyma.
Eighty-eight patients with COPD GOLD stage III or IV underwent CT and pulmonary function tests. Quantitative CT analysis was performed to determine low attenuation volume (LAV) and high attenuation volume (HAV), which are considered to be equivalents of fibrotic (HAV) and emphysematous (LAV) changes of lung parenchyma. Both parameters were determined for the whole lung, as well as peripheral and central lung areas only. Multivariate regression analysis was used to correlate HAV with different parameters of lung function.
Unlike LAV, HAV did not show significant correlation with parameters of lung function. Even in patients with a relatively high HAV of more than 10%, in contrast to HAV (=0.786) only LAV showed a significantly negative correlation with forced expiratory volume in 1 second (r=-0.309, R=0.096, =0.003). A severe decrease of DLCO% was associated with both larger HAV (=0.045) and larger LAV (=0.001). Residual volume and FVC were not influenced by LAV or HAV.
In patients with COPD GOLD stage III-IV, emphysematous changes of lung parenchyma seem to have such a strong influence on lung function, which is a possible effect of concomitant unspecific fibrosis is overwhelmed.
CT 扫描的定量分析已被证明是一种可重复的技术，它可以帮助我们了解慢性阻塞性肺疾病（COPD）和合并肺纤维化和肺气肿的病理生理学。本回顾性研究的目的是确定 COPD GOLD 分期 III 或 IV 期和肺气肿患者的肺功能是否受到高衰减区（作为肺实质非特异性纤维化改变的相关指标）的可测量影响。
88 例 COPD GOLD 分期 III 或 IV 期患者接受 CT 和肺功能检查。进行定量 CT 分析以确定低衰减体积（LAV）和高衰减体积（HAV），它们被认为是肺实质纤维化（HAV）和肺气肿（LAV）变化的等效物。这两个参数均用于整个肺、外周和中央肺区。使用多元回归分析将 HAV 与肺功能的不同参数相关联。
与 LAV 不同，HAV 与肺功能参数无显著相关性。即使在 HAV 较高（超过 10%）的患者中，与 HAV（=0.786）相比，仅 LAV 与 1 秒用力呼气量呈显著负相关（r=-0.309，R2=0.096，=0.003）。DLCO%严重下降与较大的 HAV（=0.045）和较大的 LAV（=0.001）相关。残气量和 FVC 不受 LAV 或 HAV 的影响。
在 COPD GOLD 分期 III-IV 期的患者中，肺实质的气肿性改变对肺功能的影响似乎如此强烈，以至于可能被同时存在的非特异性纤维化所掩盖。
