吸烟者的夜间低氧血症与CT测定的肺动脉增大
Nocturnal Hypoxemia and CT Determined Pulmonary Artery Enlargement in Smokers.
作者信息
Marin-Oto Marta, Seijo Luis M, Divo Miguel, Bastarrika Gorka, Ezponda Ana, Calvo Marta, Zulueta Javier J, Gallardo Guillermo, Cabezas Elena, Peces-Barba German, Pérez-Warnisher Maria T, Marín Jose M, Celli Bartolomé R, Casanova Ciro, De-Torres Juan P
机构信息
Department of Respiratory Medicine, Clínica Universidad de Navarra, University of Navarra, Avenida Pío XII, 36, 31008 Pamplona, Spain.
Department of Respiratory Medicine, Clínica Universidad de Navarra, University of Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain.
出版信息
J Clin Med. 2021 Jan 30;10(3):489. doi: 10.3390/jcm10030489.
BACKGROUND
Pulmonary artery enlargement (PAE) detected using chest computed tomography (CT) is associated with poor outcomes in chronic obstructive pulmonary disease (COPD). It is unknown whether nocturnal hypoxemia occurring in smokers, with or without COPD, obstructive sleep apnoea (OSA) or their overlap, may be associated with PAE assessed by chest CT.
METHODS
We analysed data from two prospective cohort studies that enrolled 284 smokers in lung cancer screening programs and completing baseline home sleep studies and chest CT scans. Main pulmonary artery diameter (PAD) and the ratio of the PAD to that of the aorta (PA:Ao ratio) were measured. PAE was defined as a PAD ≥ 29 mm in men and ≥27 mm in women or as a PA:Ao ratio > 0.9. We evaluated the association of PAE with baseline characteristics using multivariate logistic models.
RESULTS
PAE prevalence was 27% as defined by PAD measurements and 11.6% by the PA:Ao ratio. A body mass index ≥ 30 kg/m (OR 2.01; 95%CI 1.06-3.78), lower % predicted of forced expiratory volume in one second (FEV) (OR 1.03; 95%CI 1.02-1.05) and higher % of sleep time with O saturation < 90% (T90) (OR 1.02; 95%CI 1.00-1.03), were associated with PAE as determined by PAD. However, only T90 remained significantly associated with PAE as defined by the PA:Ao ratio (OR 1.02; 95%CI 1.01-1.03). In the subset group without OSA, only T90 remains associated with PAE, whether defined by PAD measurement (OR 1.02; 95%CI 1.01-1.03) or PA:Ao ratio (OR 1.04; 95%CI 1.01-1.07).
CONCLUSIONS
In smokers with or without COPD, nocturnal hypoxemia was associated with PAE independently of OSA coexistence.
背景
使用胸部计算机断层扫描（CT）检测到的肺动脉增大（PAE）与慢性阻塞性肺疾病（COPD）的不良预后相关。目前尚不清楚吸烟者（无论是否患有COPD、阻塞性睡眠呼吸暂停（OSA）或两者重叠）出现的夜间低氧血症是否与胸部CT评估的PAE相关。
方法
我们分析了两项前瞻性队列研究的数据，这两项研究在肺癌筛查项目中招募了284名吸烟者，并完成了基线家庭睡眠研究和胸部CT扫描。测量了主肺动脉直径（PAD）以及PAD与主动脉直径的比值（PA:Ao比值）。PAE定义为男性PAD≥29mm，女性≥27mm，或PA:Ao比值>0.9。我们使用多变量逻辑模型评估PAE与基线特征之间的关联。
结果
根据PAD测量定义的PAE患病率为27%，根据PA:Ao比值定义的患病率为11.6%。体重指数≥30kg/m（比值比2.01；95%置信区间1.06 - 3.78）、一秒用力呼气量（FEV）预测值百分比降低（比值比1.03；95%置信区间1.02 - 1.05）以及睡眠期间血氧饱和度<90%（T90）的时间百分比更高（比值比1.02；95%置信区间1.00 - 1.03），与根据PAD确定的PAE相关。然而，只有T90与根据PA:Ao比值定义的PAE仍有显著关联（比值比1.02；95%置信区间1.01 - 1.03）。在没有OSA的亚组中，无论根据PAD测量（比值比1.02；95%置信区间1.01 - 1.03）还是PA:Ao比值（比值比1.04；95%置信区间1.01 - 1.07）定义，只有T90与PAE相关。
结论
在有或没有COPD的吸烟者中，夜间低氧血症与PAE相关，且与OSA的共存无关。
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