支气管镜下肺减容术联合支气管内瓣膜对动态肺过度充气的影响：PIERCE研究结果

Impact of bronchoscopic lung volume reduction with endobronchial valves on dynamic hyperinflation: Results from the PIERCE study.

作者信息

Fumat Romane, Dupuis Marion, Mallah Siham, Heluain Valentin, Favard Florent, Simonneau Yannick, Dusselier Matthieu, Barthes Romain, Pontier Sandrine, Collot Samia, Plat Gavin, Egenod Thomas, Guibert Nicolas

机构信息

Pulmonology Department, Larrey University Hospital, Toulouse, France.

Pulmonology Department, Dupuytren University Hospital, Limoges, France.

出版信息

Respirology. 2023 Jun;28(6):525-532. doi: 10.1111/resp.14488. Epub 2023 Mar 8.

DOI:10.1111/resp.14488

PMID:36889358

Abstract

BACKGROUND AND OBJECTIVE

Dynamic hyperinflation (DH) is a major marker of exertional dyspnoea in severe emphysema. We hypothesized that bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBVs) decreases DH.

METHODS

In this prospective bi-centre study from both Toulouse and Limoges Hospitals, we assessed DH during an incremental cycle ergometry before and 3 months after EBVs treatment. The primary objective was to observe the change in inspiratory capacity (IC) at isotime. Target lobe volume reduction (TLVR) and changes in residual volume (RV), forced expiratory volume in one-second (FEV ), mMRC, 6 minutes walking distance (6MWD), BODE and other dynamic measures like tele-expiratory volume (EELV) were also analysed.

RESULTS

Thirty-nine patients were included, of whom thirty-eight presented DH. IC and EELV at isotime significantly improved (+214 mL, p = 0.004; -713 mL, p ˂ 0.001, respectively). Mean changes were +177 mL for FEV (+19%, p < 0.001), -600 mL for RV (p < 0.0001), +33 m for 6MWD (p < 0.0001), respectively. Patients who responded on RV (>430 mL decrease) and FEV (>12% gain) had better improvements compared to non-responders (+368 mL vs. +2 mL; +398 mL vs. -40 mL IC isotime, respectively). On the opposite, in patients who responded on DH (>200 mL IC isotime increase), changes in TLV (-1216 mL vs. -576 mL), FEV (+261 mL vs. +101 mL), FVC (+496 mL vs. +128 mL) and RV (-805 mL vs. -418 mL) were greater compared to non-responders.

CONCLUSIONS

DH decreases after EBVs treatment, and this improvement is correlated with static changes.

摘要

背景与目的

动态肺过度充气（DH）是重度肺气肿患者运动性呼吸困难的主要标志。我们假设使用支气管内瓣膜（EBV）进行支气管镜下肺减容术（BLVR）可减轻DH。

方法

在这项来自图卢兹医院和利摩日医院的前瞻性双中心研究中，我们在EBV治疗前和治疗后3个月的递增式运动心肺功能测试期间评估了DH。主要目的是观察等时吸气容量（IC）的变化。还分析了目标肺叶减容（TLVR）以及残气量（RV）、一秒用力呼气量（FEV）、改良英国医学研究委员会呼吸困难量表（mMRC）、6分钟步行距离（6MWD）、BODE指数以及其他动态指标如呼气末肺容积（EELV）的变化。

结果

共纳入39例患者，其中38例存在DH。等时IC和EELV显著改善（分别增加214 mL，p = 0.004；减少713 mL，p < 0.001）。FEV平均变化为增加177 mL（增加19%，p < 0.001），RV平均变化为减少600 mL（p < 0.0001），6MWD平均变化为增加33 m（p < 0.0001）。与无反应者相比，RV减少超过430 mL且FEV增加超过12%的反应者改善更明显（等时IC分别为增加368 mL对增加2 mL；增加398 mL对减少40 mL）。相反，与无反应者相比，对DH有反应（等时IC增加超过200 mL）的患者，TLV变化（减少1216 mL对减少576 mL）、FEV变化（增加261 mL对增加101 mL）、用力肺活量（FVC）变化（增加496 mL对增加128 mL）和RV变化（减少805 mL对减少418 mL）更大。