Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Tsukuba Medical Center, Tsukuba, Japan.
Respiration. 2023;102(3):194-202. doi: 10.1159/000529031. Epub 2023 Jan 23.
Physiological and prognostic associations of centrilobular emphysema (CLE) and paraseptal emphysema (PSE) in smokers with and without chronic obstructive pulmonary disease (COPD) have been increasingly recognized, but the associations with extrapulmonary abnormalities, such as muscle wasting, osteoporosis, and cardiovascular diseases, remain unestablished.
The aim of the study was to investigate whether CLE was associated with extrapulmonary abnormalities independent of concomitant PSE in smokers without airflow limitation.
This retrospective study consecutively enrolled current smokers without airflow limitation who underwent lung cancer screening with computed tomography and spirometry. CLE and PSE were visually identified based on the Fleischner Society classification system. Cross-sectional areas of pectoralis muscles (PM) and adjacent subcutaneous adipose tissue (SAT), bone mineral density (BMD), and coronary artery calcification (CAC) were evaluated.
Of 310 current smokers without airflow limitation, 83 (26.8%) had CLE. The PSE prevalence was higher (67.5% vs. 23.3%), and PM area, SAT area, and BMD were lower in smokers with CLE than in those without (PM area (mean), 34.5 versus 38.6 cm2; SAT area (mean), 29.3 versus 36.8 cm2; BMD (mean), 158.3 versus 178.4 Hounsfield unit), while CAC presence did not differ. In multivariable models, CLE was associated with lower PM area but not with SAT area or BMD, after adjusting for PSE presence, demographics, and forced expiratory volume in 1 s.
The observed association between CLE and lower PM area suggests that susceptibility to skeletal muscle loss could be high in smokers with CLE even without COPD.
在有和没有慢性阻塞性肺疾病（COPD）的吸烟者中，中心性肺气肿（CLE）和旁间隔性肺气肿（PSE）的生理和预后关联已得到越来越多的认识，但与肺外异常（如肌肉减少症、骨质疏松症和心血管疾病）的关联尚未确定。
本研究旨在调查在无气流受限的吸烟者中，CLE 是否与肺外异常有关，而与同时存在的 PSE 无关。
这项回顾性研究连续纳入了接受肺癌筛查的无气流受限的当前吸烟者，他们接受了计算机断层扫描和肺量测定。CLE 和 PSE 根据 Fleischner 学会分类系统进行视觉识别。评估胸肌（PM）和相邻皮下脂肪组织（SAT）、骨密度（BMD）和冠状动脉钙化（CAC）的横截面积。
在 310 名无气流受限的当前吸烟者中，83 名（26.8%）患有 CLE。CLE 吸烟者的 PSE 患病率较高（67.5% vs. 23.3%），PM 面积、SAT 面积和 BMD 均较低（PM 面积（均值），34.5 与 38.6cm2；SAT 面积（均值），29.3 与 36.8cm2；BMD（均值），158.3 与 178.4 豪斯菲尔德单位），而 CAC 的存在并无差异。在多变量模型中，在调整了 PSE 的存在、人口统计学和 1 秒用力呼气量后，CLE 与较低的 PM 面积相关，但与 SAT 面积或 BMD 无关。
观察到 CLE 与较低的 PM 面积之间的关联表明，即使在没有 COPD 的情况下，CLE 吸烟者的骨骼肌丧失易感性也可能很高。
