Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Radiology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan.
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Chest. 2020 Jul;158(1):121-130. doi: 10.1016/j.chest.2019.12.046. Epub 2020 Feb 1.
Mucous exudates occluding the lumen of small airways are associated with reduced lung function and mortality in subjects with COPD; however, luminal plugs in large airways have not been widely studied. We aimed to examine the associations of chest CT scan-identified luminal plugging with lung function, health-related quality of life, and COPD phenotypes.
We randomly selected 100 smokers without COPD and 400 smokers with COPD from the COPDGene Study. Luminal plugging was visually identified on inspiratory CT scans at baseline and 5-year follow-up. The relationships of luminal plugging to FEV, St. George's Respiratory Questionnaire (SGRQ) score, emphysema on CT scan (defined as the percentage of low attenuation area < 950 Hounsfield units [%LAA-950]), and chronic bronchitis were assessed using linear and logistic multivariable analyses.
Overall, 111 subjects (22%) had luminal plugging. The prevalence of luminal plugging was higher in subjects with COPD than those without COPD (25% vs 10%, respectively; P = .001). In subjects with COPD, luminal plugging was significantly associated with FEV % predicted (estimate, -6.1; SE, 2.1; P = .004) and SGRQ score (estimate, 4.9; SE, 2.4; P = .04) in adjusted models. Although luminal plugging was associated with log %LAA-950 (estimate, 0.43; SE, 0.16; P = .007), its relationship with chronic bronchitis did not reach statistical significance (P = .07). Seventy-three percent of subjects with COPD with luminal plugging at baseline had it 5 years later.
In subjects with COPD, CT-identified luminal plugging is associated with airflow obstruction, worse health-related quality of life, and emphysema phenotype. This imaging feature may supplement the current clinical assessment of chronic mucus hypersecretion in COPD.
小气道管腔中的黏液渗出物与 COPD 患者的肺功能降低和死亡率有关；然而，大气道中的管腔堵塞尚未得到广泛研究。我们旨在研究胸部 CT 扫描识别的管腔堵塞与肺功能、健康相关生活质量和 COPD 表型的相关性。
我们从 COPDGene 研究中随机选择了 100 名无 COPD 的吸烟者和 400 名有 COPD 的吸烟者。在基线和 5 年随访时，通过吸气 CT 扫描对管腔堵塞进行目视识别。使用线性和逻辑多变量分析评估管腔堵塞与 FEV1、圣乔治呼吸问卷（SGRQ）评分、CT 扫描上的肺气肿（定义为低衰减区域<950 个亨氏单位的百分比 [%LAA-950]）和慢性支气管炎之间的关系。
总体而言，111 名受试者（22%）存在管腔堵塞。与无 COPD 的受试者相比，有 COPD 的受试者中管腔堵塞的患病率更高（分别为 25%和 10%；P=0.001）。在 COPD 患者中，管腔堵塞与 FEV1%预计值（估计值，-6.1；SE，2.1；P=0.004）和 SGRQ 评分（估计值，4.9；SE，2.4；P=0.04）在调整后的模型中显著相关。尽管管腔堵塞与 log %LAA-950 相关（估计值，0.43；SE，0.16；P=0.007），但其与慢性支气管炎的关系未达到统计学意义（P=0.07）。73%的基线时存在管腔堵塞的 COPD 患者在 5 年后仍存在该问题。
在 COPD 患者中，CT 识别的管腔堵塞与气流阻塞、更差的健康相关生活质量和肺气肿表型相关。这种影像学特征可能补充 COPD 中慢性黏液高分泌的当前临床评估。
