Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai St. Lukes, Mount Sinai West, Mount Sinai Beth Israel, New York, NY, United States of America.
Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America.
Clin Imaging. 2021 Oct;78:136-141. doi: 10.1016/j.clinimag.2021.03.012. Epub 2021 Mar 20.
Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD.
We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program.
Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (OR = 0.72, p < 0.0001), lower pack-years of smoking (OR = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was OR = 0.58(p = 0.0007) and for severe emphysema, it was OR = 0.23(p < 0.0001).
Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.
慢性阻塞性肺疾病（COPD）包括慢性支气管炎、小气道疾病和肺气肿。COPD 的诊断需要肺量计证据，即使存在小气道疾病或肺气肿，也可能正常。肺气肿会增加恶化的风险，并与全因死亡率和肺癌风险增加相关。我们评估了有和无 COPD 既往史的参与者中肺气肿的患病率。
我们回顾了 2003 年至 2016 年期间，在国际早期肺癌行动计划中进行基线低剂量 CT 筛查肺癌的前瞻性队列研究中的 52726 名参与者。
在 52726 名参与者中，23.8%（12542 人）有 CT 肺气肿证据。在这 12542 名患有肺气肿的参与者中，76.5%（9595/12542）无 COPD 既往诊断，尽管 23.6%（2258/9595）有中重度肺气肿。在 12542 名参与者中，无 COPD 既往诊断的显著预测因素包括：男性（OR=1.47，p<0.0001）、年龄较小（OR=0.72，p<0.0001）、吸烟包年数较低（OR=0.90，p<0.0001）、完成大学或以上教育（OR=1.54，p<0.0001）、无肺癌家族史（OR=1.12，p=0.04）、无自我报告的心脏病（OR=0.76，p=0.0003）或高血压（OR=0.74，p<0.0001）。在 9595 名无 COPD 既往诊断的参与者中，肺气肿的严重程度明显较低，中度肺气肿的比值比（OR）为 0.58（p=0.0007），重度肺气肿的 OR 为 0.23（p<0.0001）。
在接受 LDCT 的参与者中，有 23.8%的人发现了肺气肿，而有 76.5%的人未被怀疑。LDCT 提供了一个识别肺气肿的机会，并建议戒烟。
