基于高分辨率 CT 的视觉亚型和低衰减区对 COPD 的诊断效能。
Diagnostic efficacy of visual subtypes and low attenuation area based on HRCT in the diagnosis of COPD.
机构信息
Department of Radiology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong New Area, Shanghai, 200120, China.
Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
出版信息
BMC Pulm Med. 2022 Mar 6;22(1):81. doi: 10.1186/s12890-022-01875-6.
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease. Current gold standard criteria, pulmonary function tests (PFTs) may result in underdiagnosis of potential COPD patients. Therefore, we hypothesize that the combination of high-resolution computed tomography (HRCT) and clinical basic characteristics will enable the identification of more COPD patients.
METHODS
A total of 284 patients with respiratory symptoms who were current or former smokers were included in the study, and were further divided into 5 groups of GOLD grade I-IV and non-COPD according to PFTs. All patients underwent inspiratory HRCT scanning and low attenuation area (LAA) was measured. Then they were divided into seven visual subtypes according to the Fleischner Society classification system. Non-parametric tests were used for exploring differences in basic characteristics and PFTs between different groups of enrolled patients and visual subtypes. Binary logistic regression was to find the influencing factors that affected the patients' outcome (non-COPD vs GOLD I-IV). The area under the receiver operating characteristic curve (AUC-ROC) was to explore the diagnostic efficacy of LAA, visual subtypes, and combined basic characteristics related to COPD for COPD diagnosis. Finally, based on the cut-off values of ROC analysis, exploring HRCT features in patients who do not meet the diagnostic criteria but clinically suspected COPD.
RESULTS
With the worsening severity of COPD, the visual subtypes gradually progressed (p < 0.01). There was a significant difference in LAA between GOLD II-IV and non-COPD (p < 0.0001). The diagnostic efficacy of LAA, visual subtypes, and LAA combined with visual subtypes for COPD were 0.742, 0.682 and 0.730 respectively. The diagnostic efficacy increased to 0.923-0.943 when basic characteristics were added (all p < 0.001). Based on the cut-off value of ROC analysis, LAA greater than 5.6, worsening of visual subtypes, combined with positive basic characteristics can help identify some potential COPD patients.
CONCLUSION
The heterogeneous phenotype of COPD requires a combination of multiple evaluation methods. The diagnostic efficacy of combining LAA, visual subtypes, and basic characteristics achieves good consistency with current diagnostic criteria.
背景
慢性阻塞性肺疾病（COPD）是一种异质性疾病。目前的金标准标准，肺功能测试（PFTs）可能导致潜在 COPD 患者的诊断不足。因此，我们假设高分辨率计算机断层扫描（HRCT）和临床基本特征的组合将能够识别更多的 COPD 患者。
方法
共纳入 284 例有呼吸系统症状的患者，均为现吸烟者或曾吸烟者，并根据 PFTs 进一步分为 GOLD 分级 I-IV 组和非 COPD 组。所有患者均行吸气 HRCT 扫描，并测量低衰减区（LAA）。然后根据 Fleischner 学会分类系统将其分为七种视觉亚型。采用非参数检验比较不同分组和视觉亚型患者的基本特征和 PFTs 的差异。采用二元逻辑回归分析影响患者结局（非 COPD 与 GOLD I-IV）的影响因素。采用受试者工作特征曲线下面积（AUC-ROC）探讨 LAA、视觉亚型以及与 COPD 相关的联合基本特征对 COPD 诊断的诊断效能。最后，根据 ROC 分析的截断值，探讨不符合诊断标准但临床上疑似 COPD 的患者的 HRCT 特征。
结果
随着 COPD 严重程度的加重，视觉亚型逐渐进展（p<0.01）。GOLD II-IV 与非 COPD 之间的 LAA 差异有统计学意义（p<0.0001）。LAA、视觉亚型以及 LAA 联合视觉亚型对 COPD 的诊断效能分别为 0.742、0.682 和 0.730。当加入基本特征时，诊断效能增加至 0.923-0.943（均 p<0.001）。根据 ROC 分析的截断值，LAA 大于 5.6、视觉亚型恶化以及联合阳性基本特征有助于识别一些潜在的 COPD 患者。
结论
COPD 的异质表型需要多种评估方法的结合。LAA、视觉亚型和基本特征的联合诊断效能与目前的诊断标准具有良好的一致性。
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