Choi Bina, Kawut Steven M, Raghu Ganesh, Hoffman Eric, Tracy Russell, Madahar Purnema, Bernstein Elana J, Barr R Graham, Lederer David J, Podolanczuk Anna
Columbia University Medical Center, New York, NY, USA.
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
ERJ Open Res. 2020 Mar 2;6(1). doi: 10.1183/23120541.00115-2019. eCollection 2020 Jan.
High-attenuation areas (HAA) are a computed tomography-based quantitative measure of subclinical interstitial lung disease (ILD). We aimed to validate HAA in lung regions that are less subject to artefacts, such as extravascular lung water or dependent atelectasis. We examined the associations of HAA within six lung regions (basilar, non-basilar, peel, core, basilar peel, basilar core) with serum biomarkers of lung remodelling, forced vital capacity (FVC), visually-assessed interstitial lung abnormalities (ILA), and all-cause and ILD-specific mortality. We performed cross-sectional and longitudinal analyses of participants in the Multi-Ethnic Study of Atherosclerosis, a prospective cohort of 6814 adults aged 45-84 years without known cardiovascular disease who underwent cardiac computed tomography. Median regional HAA ranged from 3.8% in the peel to 4.8% in the basilar core. Doubling of regional HAA was associated with greater serum matrix metalloproteinase-7 (range 3.8% to 10.3%; p≤0.01), higher odds of ILA (OR 1.42 to 2.20; p≤0.03), and a higher risk of all-cause mortality (hazard ratio 1.20 to 1.47; p≤0.001). Doubling of regional HAA was associated with greater serum interleukin-6 (4.9% to 10.3%; p≤0.005) and higher risk of ILD-specific mortality (hazard ratio 3.30 to 3.98; p<0.001), except in the basilar core. Doubling of regional HAA was associated with lower FVC in the non-basilar, core and basilar core (113 mL to 186 mL; p<0.001). Associations of HAA with lung remodelling biomarkers, ILA risk and all-cause mortality were consistent across all regions of the lung, including dependent areas where atelectasis may be present. These findings support the validity of HAA as a measure of pathologic subclinical ILD.
高衰减区域（HAA）是基于计算机断层扫描的亚临床间质性肺疾病（ILD）的定量指标。我们旨在验证在较少受诸如血管外肺水或依赖性肺不张等伪影影响的肺区域中的HAA。我们研究了六个肺区域（基底、非基底、外周、核心、基底外周、基底核心）内的HAA与肺重塑的血清生物标志物、用力肺活量（FVC）、视觉评估的间质性肺异常（ILA）以及全因死亡率和ILD特异性死亡率之间的关联。我们对动脉粥样硬化多民族研究中的参与者进行了横断面和纵向分析，该研究是一个由6814名年龄在45 - 84岁、无已知心血管疾病的成年人组成的前瞻性队列，他们接受了心脏计算机断层扫描。区域HAA的中位数范围从外周的3.8%到基底核心的4.8%。区域HAA翻倍与更高的血清基质金属蛋白酶-7相关（范围为3.8%至10.3%；p≤0.01）、ILA几率更高（OR为1.42至2.20；p≤0.03）以及全因死亡率风险更高（风险比为1.20至1.47；p≤0.001）。区域HAA翻倍与更高的血清白细胞介素-6相关（4.9%至10.3%；p≤0.005）以及ILD特异性死亡率风险更高（风险比为3.30至3.98；p<0.001），基底核心区域除外。区域HAA翻倍与非基底、核心和基底核心区域的FVC降低相关（113 mL至186 mL；p<0.001）。HAA与肺重塑生物标志物、ILA风险和全因死亡率之间的关联在肺的所有区域都是一致的，包括可能存在肺不张的依赖性区域。这些发现支持了HAA作为病理性亚临床ILD指标的有效性。
