Shiraishi Yusuke, Shimada Takafumi, Tanabe Naoya, Terada Kunihiko, Sakamoto Ryo, Maetani Tomoki, Shima Hiroshi, Mochizuki Fumi, Oguma Tsuyoshi, Shimizu Kaoruko, Sato Susumu, Muro Shigeo, Hizawa Nobuyuki, Fukui Motonari, Iijima Hiroaki, Masuda Izuru, Hirai Toyohiro
Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Respiratory Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan.
ERJ Open Res. 2022 Jun 27;8(2). doi: 10.1183/23120541.00063-2022. eCollection 2022 Apr.
Centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are observed in smokers with preserved ratio impaired spirometry (PRISm, defined as the ratio of forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ≥0.7 and FEV <80%), but their prevalence and physiological impacts remain unestablished. This multicentre study aimed to investigate its prevalence and to test whether emphysema subtypes are differently associated with physiological impairments in smokers with PRISm. Both never- and ever-smokers aged ≥40 years who underwent computed tomography (CT) for lung cancer screening and spirometry were retrospectively and consecutively enrolled at three hospitals and a clinic. Emphysema subtypes were visually classified according to the Fleischner system. Air-trapping was assessed as the ratio of FVC to total lung capacity on CT (TLC). In 1046 never-smokers and 772 smokers with ≥10 pack-years, the prevalence of PRISm was 8.2% and 11.3%, respectively. The prevalence of PSE and CLE in smokers with PRISm was comparable to that in smokers with normal spirometry (PSE 43.7% 36.2%, p=1.00; CLE 46.0% 31.8%, p=0.21), but higher than that in never-smokers with PRISm (PSE 43.7% 1.2%, p<0.01; CLE 46% 4.7%, p<0.01) and lower than that in smokers with airflow limitation (PSE 43.7% 71.0%, p<0.01; CLE 46% 79.3%, p<0.01). The presence of CLE, but not PSE, was independently associated with reduced FVC/TLC in smokers with PRISm. Both PSE and CLE were common, but only CLE was associated with air-trapping in smokers with PRISm, suggesting different physiological roles of these emphysema subtypes.
在肺功能测定指标异常但比值保留（PRISm，定义为1秒用力呼气容积（FEV）与用力肺活量（FVC）之比≥0.7且FEV<80%）的吸烟者中观察到小叶中心型肺气肿（CLE）和间隔旁肺气肿（PSE），但其患病率和对生理功能的影响仍不明确。这项多中心研究旨在调查其患病率，并测试肺气肿亚型与PRISm吸烟者生理功能损害之间是否存在不同关联。年龄≥40岁、因肺癌筛查接受计算机断层扫描（CT）和肺功能测定的从不吸烟者和曾经吸烟者，在三家医院和一家诊所进行回顾性连续入组。根据Fleischner系统对肺气肿亚型进行视觉分类。将CT上的空气潴留评估为FVC与肺总量（TLC）之比。在1046名从不吸烟者和772名吸烟史≥10包年的吸烟者中，PRISm的患病率分别为8.2%和11.3%。PRISm吸烟者中PSE和CLE的患病率与肺功能正常的吸烟者相当（PSE 43.7%对36.2%，p=1.00；CLE 46.0%对31.8%，p=0.21），但高于PRISm的从不吸烟者（PSE 43.7%对1.2%，p<0.01；CLE 46%对4.7%，p<0.01），且低于气流受限吸烟者（PSE 43.7%对71.0%，p<0.01；CLE 46%对79.3%，p<0.01）。在PRISm吸烟者中，CLE的存在而非PSE与FVC/TLC降低独立相关。PSE和CLE在PRISm吸烟者中都很常见，但只有CLE与空气潴留相关，提示这些肺气肿亚型具有不同的生理作用。
