From the Adult CF Unit (T.S.F., D.S.N., M.J.W.) and Department of Radiology (C.M.), Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK; Institute of Life Course and Medical Sciences (T.S.F., P.S.M.) and Institute of Infection and Global Health (D.S.N., M.J.W.), University of Liverpool, Liverpool, UK; and Institute in the Park (University of Liverpool), Alder Hey Children's Hospital, Liverpool, UK (P.S.M.).
Radiology. 2022 Jun;303(3):675-681. doi: 10.1148/radiol.212641. Epub 2022 Mar 15.
Background Although spirometry is an important marker in the management of pulmonary exacerbations in cystic fibrosis (CF), it is a forced maneuver and can generate aerosol. Therefore, it may be difficult to perform in some individuals. Dynamic chest radiography (DCR) provides real-time information regarding pulmonary dynamics alongside fluoroscopic-style thoracic imaging. Purpose To assess the effect of pulmonary exacerbation treatment by using both spirometry and DCR and assess the clinical utility of DCR in participants with CF experiencing pulmonary exacerbations. Materials and Methods In this prospective, observational, single-center pilot study, spirometry and DCR were performed before and after treatment of pulmonary exacerbations in participants with CF between December 2019 and August 2020. Spirometry measured forced expiratory volume in 1 second (FEV) and forced vital capacity. DCR helped to measure projected lung area (PLA), hemidiaphragm midpoint position, and speed during tidal and deep breathing. Data were analyzed by using the paired test or Wilcoxon signed-rank test. Correlation was assessed by using the Spearman rank correlation coefficient. Results Twenty participants with CF (mean age, 25 years ± 7 [standard deviation]; 14 women) were evaluated. Spirometry showed that percentage predicted FEV improved from a median of 44% (interquartile range [IQR], 17%) before treatment to 55% (IQR, 16%) after treatment ( = .004). DCR showed improvement in median deep breathing excursion for left and right hemidiaphragms (from 18 [IQR, 11] to 25 [IQR, 16] mm [ = .03] and from 13 [IQR, 6] to 19 [IQR, 14] mm [ = .03], respectively) and in median expiratory speed following deep breathing for left and right hemidiaphragms (from 7 [IQR, 2] to 11 [IQR, 5] mm/sec [ = .004] and 6 [IQR, 3] to 9 [IQR, 6] mm/sec [ = .004], respectively). PLA rate of change during full expiration and change in PLA during tidal breathing improved (from a mean of 42 cm/sec ± 16 to 56 cm/sec ± 24 [ = .03] and from a mean of 29 cm ± 14 to 35 cm ± 10 [ = .03], respectively). Conclusion Dynamic chest radiography demonstrated improvement in diaphragm speed and range of chest wall movement during respiration aftere treatment for pulmonary exacerbations in cystic fibrosis and showed potential as a tool to investigate the effect of pulmonary exacerbations on lung mechanics. Clinical trials registration no. NCT01234567 Published under a CC BY 4.0 license.
背景 虽然肺活量测定法是囊性纤维化（CF）肺部恶化管理的重要指标，但它是一种强制操作，会产生气溶胶。因此，在某些个体中可能难以进行。动态胸部 X 线摄影（DCR）可提供有关肺部动态的实时信息，以及透视式胸部成像。目的 评估使用肺活量测定法和 DCR 治疗肺部恶化的效果，并评估 DCR 在经历肺部恶化的 CF 参与者中的临床应用价值。材料与方法 本前瞻性、观察性、单中心试点研究于 2019 年 12 月至 2020 年 8 月期间，对 CF 患者肺部恶化治疗前后进行了肺活量测定法和 DCR 检查。肺活量测定法测量了 1 秒用力呼气量（FEV1）和用力肺活量。DCR 有助于测量投影肺面积（PLA）、半膈肌中点位置以及潮式呼吸和深呼吸时的速度。通过配对 t 检验或 Wilcoxon 符号秩检验分析数据。通过 Spearman 秩相关系数评估相关性。结果 对 20 名 CF 患者（平均年龄 25 岁±7[标准差]；14 名女性）进行了评估。肺活量测定法显示，治疗前预测 FEV1 的百分比中位数从 44%（IQR，17%）提高到 55%（IQR，16%）（ =.004）。DCR 显示左、右膈肌深吸气的中位数明显改善（从 18 [IQR，11]至 25 [IQR，16]mm [ =.03]和从 13 [IQR，6]至 19 [IQR，14]mm [ =.03]），左、右膈肌深吸气后的呼气速度中位数也明显改善（从 7 [IQR，2]至 11 [IQR，5]mm/sec [ =.004]和 6 [IQR，3]至 9 [IQR，6]mm/sec [ =.004]）。完全呼气时 PLA 的变化率和潮式呼吸时 PLA 的变化均有所改善（从平均 42cm/sec±16 增加到 56cm/sec±24 [ =.03]和从平均 29cm±14 增加到 35cm±10 [ =.03]）。结论 DCR 显示 CF 肺部恶化治疗后，呼吸时膈肌速度和胸廓运动范围均有改善，可能是一种研究肺部恶化对肺力学影响的工具。临床试验注册号 NCT01234567 发表于 CC BY 4.0 许可下。
