吸烟者中存在和不存在慢性阻塞性肺疾病（COPD）者的 CT 肺气肿和空气潴留的 5 年进展：来自 COPDGene 研究的结果。
Five-year Progression of Emphysema and Air Trapping at CT in Smokers with and Those without Chronic Obstructive Pulmonary Disease: Results from the COPDGene Study.
机构信息
From the Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, PO 85500, Postbox E.03.511, Utrecht, Utrecht 3508 GA, the Netherlands (E.P.); Division of Biostatistics and Bioinformatics (M.S., B.J.M.), Department of Radiology (S.H., D.A.L.), Division of Rheumatology, Department of Medicine (E.A.R.), and Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine (J.D.C.), National Jewish Health, Denver, Colo; Thirona, Nijmegen, the Netherlands (E.M.v.R.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (E.M.v.R., J.P.C.); Departments of Biomedical Engineering, Radiology, and Internal Medicine, University of Iowa, Iowa City, Iowa (E.A.H.); Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY (R.G.B.); Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, Mich (M.K.H.); Department of Epidemiology, University of Colorado Denver, Denver, Colo (J.E.H.); and Channing Division of Network Medicine (E.K.S.) and Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.), Brigham and Women's Hospital, Boston, Mass.
出版信息
Radiology. 2020 Apr;295(1):218-226. doi: 10.1148/radiol.2020191429. Epub 2020 Feb 4.
Background CT is used to quantify abnormal changes in the lung parenchyma of smokers that might overlap chronic obstructive pulmonary disease (COPD), but studies on the progression of expiratory air trapping in smokers are scarce. Purpose To evaluate the relationship between longitudinal changes in forced expiratory volume in 1 second (FEV) and CT-quantified emphysema and air trapping in smokers. Materials and Methods Cigarette smokers with and those without COPD participating in the multicenter observational COPDGene study were evaluated. Subjects underwent inspiratory and expiratory chest CT and spirometry at baseline and 5-year follow-up. Emphysema was quantified by using adjusted lung density (ALD). Air trapping was quantified by using mean lung density at expiratory CT and CT-measured functional residual capacity-to-total lung volume ratio. Linear models were used to regress quantitative CT measurements taken 5 years apart, and models were fit with and without adding FEV as a predictor. Analyses were stratified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (GOLD 0, no COPD; GOLD 1, mild COPD; GOLD 2, moderate COPD; GOLD 3, severe COPD; GOLD 4, very severe COPD). Subjects with preserved FEV-to-forced vital capacity ratio and reduced FEV percentage predicted were categorized as having preserved ratio impaired spirometry (PRISm). Results A total of 4211 subjects (503 with PRISm; 2034 with GOLD 0, 388 with GOLD 1, 816 with GOLD 2, 381 with GOLD 3, 89 with GOLD 4) were evaluated. ALD decreased by 1.7 g/L (95% confidence interval [CI]: -2.5, -0.9) in subjects with GOLD 0 at baseline and by 5.3 g/L (95% CI: -6.2, -4.4) in those with GOLD 1-4 ( < .001 for both). When adjusted for changes in FEV, corresponding numbers were -2.2 (95% CI: -3.0, -1.3) and -4.6 g/L (95% CI: -5.6, -3.4) ( < .001 for both). Progression in air trapping was identified only in GOLD stage 2-4. Approximately 33%-50% of changes in air trapping in GOLD stages 2-4 were accounted for by changes in FEV. Conclusion CT measures of emphysema and air trapping increased over 5 years in smokers. Forced expiratory volume in one second accounted for less than 10% of emphysema progression and less than 50% of air trapping progression detected at CT. © RSNA, 2020
背景 CT 用于量化吸烟者肺实质的异常变化，这些变化可能与慢性阻塞性肺疾病（COPD）重叠，但关于吸烟者呼气性空气潴留进展的研究很少。目的 评估用力呼气量（FEV）的纵向变化与吸烟者 CT 定量肺气肿和空气潴留之间的关系。材料与方法 评估了参加多中心观察性 COPDGene 研究的吸烟者和非 COPD 吸烟者。受试者在基线和 5 年随访时接受吸气和呼气胸部 CT 和肺活量测定。肺气肿通过调整后的肺密度（ALD）进行量化。空气潴留通过呼气 CT 的平均肺密度和 CT 测量的功能残气量与总肺容量比进行量化。使用线性模型回归 5 年内的定量 CT 测量值，并在模型中加入和不加入 FEV 作为预测因子进行拟合。根据全球慢性阻塞性肺疾病倡议（GOLD）分期（GOLD 0，无 COPD；GOLD 1，轻度 COPD；GOLD 2，中度 COPD；GOLD 3，重度 COPD；GOLD 4，极重度 COPD）进行分层分析。FEV 与用力肺活量比保留和 FEV 百分比预测降低的患者被归类为保留比受损的肺量计（PRISm）。结果 共评估了 4211 例患者（503 例 PRISm；2034 例 GOLD 0，388 例 GOLD 1，816 例 GOLD 2，381 例 GOLD 3，89 例 GOLD 4）。基线时 GOLD 0 患者的 ALD 下降 1.7 g/L（95%置信区间[CI]：-2.5，-0.9），GOLD 1-4 患者下降 5.3 g/L（95% CI：-6.2，-4.4）（均<0.001）。当调整 FEV 的变化时，相应的数值分别为-2.2（95% CI：-3.0，-1.3）和-4.6 g/L（95% CI：-5.6，-3.4）（均<0.001）。仅在 GOLD 2-4 期才发现空气潴留的进展。GOLD 2-4 期空气潴留变化的约 33%-50%可归因于 FEV 的变化。结论 在吸烟者中，CT 测量的肺气肿和空气潴留在 5 年内增加。FEV 仅解释了 CT 检测到的肺气肿进展的不到 10%和空气潴留进展的不到 50%。
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