Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
Department of Internal Medicine, Tenshindo Hetsugi Hospital, 5956 Nihongi, Nakahetsugi, Oita, 879-7761, Japan.
Sci Rep. 2022 May 16;12(1):8023. doi: 10.1038/s41598-022-12092-w.
Although lung involvement in aspiration pneumonia typically has a gravity-dependent distribution on chest images, which patient's conditions contribute to its radiological pattern has not been fully elucidated. This study was designed to determine the factors associated with the gravity-dependent distribution of community-acquired pneumonia (CAP) on chest computed tomography (CT). This retrospective study included elderly patients aged ≥ 65 years with CAP who underwent chest CT within 1 week before or after admission. The factors associated with lower lobe- and posterior-predominant distributions of ground glass opacity or airspace consolidation were determined. Of the 369 patients with CAP, 348 (94%) underwent chest CT. Multivariate analyses showed that impaired consciousness, a low Barthel index of activities of daily living, and high hemoglobin levels were associated with lower lobe-predominant distribution, while male sex and impaired consciousness were associated with posterior-predominant distribution. Cerebrovascular diseases were unrelated to these distributions. While male sex, impaired consciousness, high hemoglobin levels, low albumin levels, and the number of involved lobes were associated with in-hospital mortality, gravity-dependent distributions were not. Impaired consciousness might be the most significant predictor of aspiration pneumonia; however, the gravity-dependent distribution of this disease is unlikely to affect disease prognosis.
虽然吸入性肺炎在胸部影像上的肺部受累通常具有重力依赖性分布，但哪些患者的情况导致其影像学模式尚未完全阐明。本研究旨在确定与社区获得性肺炎（CAP）在胸部计算机断层扫描（CT）上的重力依赖性分布相关的因素。这项回顾性研究纳入了年龄≥65 岁的 CAP 老年患者，他们在入院前或入院后 1 周内接受了胸部 CT 检查。确定与磨玻璃影或空气空间实变的下叶和后叶优势分布相关的因素。在 369 例 CAP 患者中，有 348 例（94%）接受了胸部 CT 检查。多变量分析显示，意识障碍、日常生活活动的 Barthel 指数低和血红蛋白水平高与下叶优势分布相关，而男性和意识障碍与后叶优势分布相关。脑血管疾病与这些分布无关。虽然男性、意识障碍、高血红蛋白水平、低白蛋白水平和受累肺叶数量与住院死亡率相关，但重力依赖性分布与住院死亡率无关。意识障碍可能是吸入性肺炎的最重要预测因素；然而，这种疾病的重力依赖性分布不太可能影响疾病预后。
