西罗莫司治疗淋巴管平滑肌瘤病患者肺部计算机断层扫描的定量分析
Quantitative analysis of computed tomography of the lungs in patients with lymphangioleiomyomatosis treated with sirolimus.
作者信息
Ko Yuki, Asakawa Katsuaki, Tobino Kazunori, Oguma Tsuyoshi, Hirai Toyohiro, Takada Toshinori, Takahashi Kazuhisa, Seyama Kuniaki
机构信息
Division of Respiratory Medicine, Iizuka Hospital, Yoshio-Machi 3-83, Iizuka-Shi, Fukuoka 820-8505, Japan.
Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan.
出版信息
Heliyon. 2020 Feb 6;6(2):e03345. doi: 10.1016/j.heliyon.2020.e03345. eCollection 2020 Feb.
OBJECTIVES
We aimed to study sirolimus-related lung parenchymal changes by quantitative analysis of computed tomography (CT) of the lungs in patients with lymphangioleiomyomatosis (LAM).
METHODS
We studied 20 participants from the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety study, who had undergone both thin-section CT scans and pulmonary function tests at baseline, 12, and 24 months. Quantitative CT parameters such as CT-derived total lung capacity, percentage of low attenuation area (LAA%), lung density histogram, fractal property of low attenuation area, and airway dimensions were analyzed, and correlations were conducted between the longitudinal change in each quantitative CT measurement and changes in pulmonary function were examined. Among 20 participants, pre-trial (n = 8) and post-trial (n = 16) CT data were also analyzed to deduce pathophysiologic implications of the serial changes in CT parameters during trial periods.
RESULTS
FEV significantly increased from baseline to 24 months (slope 3.71 ± 1.50 ml/month) whereas FVC didn't during sirolimus therapy. Strikingly, LAA%, and skewness and kurtosis of density histogram significantly increased from baseline to 24 months, while mean and mode CT values significantly decreased from baseline to 24 months. Statistically significant positive correlations were found between ΔFEV and Δskewness ( = 0.465, = 0.045). Taking the changes in lung density during pre-trial period into consideration, sirolimus decreases the area of -800 to -750 Housefield unit (HU) density and inhibits the decrease of -950 to -800 HU area during treatment, then producing the increased LAA% during the trial and post-trial periods. Given few sirolimus-related changes in airway dimensions, possible changes in lung mechanics may have contributed to increased FEV.
CONCLUSION
Our study suggests that the lung density histogram parameters, kurtosis, and skewness, may be useful as indicators of the efficacy of sirolimus.
目的
我们旨在通过对淋巴管平滑肌瘤病（LAM）患者肺部计算机断层扫描（CT）进行定量分析，研究西罗莫司相关的肺实质变化。
方法
我们对多中心淋巴管平滑肌瘤病西罗莫司安全性试验研究中的20名参与者进行了研究，这些参与者在基线、12个月和24个月时均接受了薄层CT扫描和肺功能测试。分析了CT衍生的肺总量、低衰减区百分比（LAA%）、肺密度直方图、低衰减区分形特性和气道尺寸等定量CT参数，并对每个定量CT测量值的纵向变化与肺功能变化之间进行了相关性分析。在20名参与者中，还分析了试验前（n = 8）和试验后（n = 16）的CT数据，以推断试验期间CT参数系列变化的病理生理意义。
结果
在西罗莫司治疗期间，FEV从基线到24个月显著增加（斜率为3.71±1.50 ml/月），而FVC没有变化。令人惊讶的是，LAA%以及密度直方图的偏度和峰度从基线到24个月显著增加，而平均CT值和众数CT值从基线到24个月显著降低。在ΔFEV和Δ偏度之间发现了具有统计学意义的正相关（r = 0.465，P = 0.045）。考虑到试验前期肺密度的变化，西罗莫司在治疗期间减小了-800至-750亨氏单位（HU）密度的区域，并抑制了-950至-800 HU区域的减小，从而在试验期间和试验后期导致LAA%增加。鉴于与西罗莫司相关的气道尺寸变化很少，肺力学的可能变化可能导致了FEV增加。
结论
我们的研究表明，肺密度直方图参数、峰度和偏度可能作为西罗莫司疗效的指标。
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