Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Chest. 2023 Aug;164(2):327-338. doi: 10.1016/j.chest.2023.01.034. Epub 2023 Jan 31.
The factors associated with longitudinal changes in diffusing capacity remain unclear among patients with COPD. Centrilobular emphysema (CLE) and paraseptal emphysema (PSE) are major emphysema subtypes that may have distinct clinical-physiological impacts in these patients.
Are CLE and PSE differently associated with longitudinal changes in diffusing capacity and mortality in patients with COPD?
This pooled analysis included 399 patients with COPD from two prospective observational COPD cohorts. CLE and PSE were visually assessed on CT scan according to the Fleischner Society statement. The diffusing capacity and transfer coefficient of the lung for carbon monoxide (Dlco and K) and FEV were evaluated at least annually over a 5-year period. Mortality was recorded over 10 years. Longitudinal changes in FEV, Dlco, and K and mortality were compared between mild or less severe and moderate or more severe CLE and between present and absent PSE in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage.
The Dlco and K decline was weakly associated with FEV and greater in GOLD stage 3 or higher than in GOLD stages 1 and 2. Furthermore, moderate or more severe CLE, but not present PSE, was associated with steeper declines in Dlco for GOLD stages 1 and 3 or higher and K for all GOLD stages independent of age, sex, height, and smoking history. The moderate or more severe CLE, but not present PSE, was associated with additional FEV decline and higher 10-year mortality among patients with GOLD stage 3 or higher.
A CT scan finding of moderate or more severe CLE, but not PSE, was associated with a subsequent accelerated impairment in diffusing capacity and higher long-term mortality in severe GOLD stage among patients with COPD.
在 COPD 患者中，与弥散量纵向变化相关的因素尚不清楚。中央性肺气肿（CLE）和旁间隔性肺气肿（PSE）是主要的肺气肿亚型，它们在这些患者中可能具有不同的临床生理影响。
CLE 和 PSE 是否与 COPD 患者弥散量和死亡率的纵向变化有不同的关联？
本 pooled 分析纳入了来自两个前瞻性观察性 COPD 队列的 399 例 COPD 患者。根据 Fleischner 学会的声明，在 CT 扫描上评估 CLE 和 PSE。在 5 年内至少每年评估弥散量和一氧化碳肺转移系数（Dlco 和 K）以及 FEV。记录 10 年的死亡率。在每个 GOLD 阶段，比较轻或较轻和中或较重 CLE 之间以及每个 GOLD 阶段的 PSE 存在和不存在之间的 FEV、Dlco 和 K 的纵向变化以及死亡率。
Dlco 和 K 的下降与 FEV 呈弱相关，在 GOLD 3 或更高阶段比在 GOLD 1 和 2 阶段更明显。此外，中或较重的 CLE 而不是目前的 PSE 与 GOLD 1 和 3 或更高阶段的 Dlco 下降更陡峭以及所有 GOLD 阶段的 K 下降有关，独立于年龄、性别、身高和吸烟史。中或较重的 CLE 而不是目前的 PSE 与 GOLD 3 或更高阶段患者的额外 FEV 下降和更高的 10 年死亡率相关。
中或较重的 CLE（而非 PSE）的 CT 扫描结果与严重 GOLD 阶段 COPD 患者随后弥散量受损加速和长期死亡率升高有关。
