Hermann Emilia A, Motahari Amin, Hoffman Eric A, Sun Yifei, Allen Norrina, Angelini Elsa D, Bertoni Alain G, Bluemke David A, Gerard Sarah E, Guo Junfeng, Kaczka David W, Laine Andrew, Michos Erin, Nagpal Prashant, Pankow James S, Sack Coralynn S, Smith Benjamin, Stukovsky Karen Hinckley, Watson Karol E, Wysoczanski Artur, Barr R Graham
Columbia University Irving Medical Center, New York, New York, USA
University of Iowa, Iowa City, Iowa, USA.
Thorax. 2025 Apr 15;80(5):309-317. doi: 10.1136/thorax-2024-222002.
Pulmonary microvasculature alterations are implicated in emphysema pathogenesis, but the association between pulmonary microvascular blood volume (PMBV) and emphysema has not been directly assessed at scale, and prior studies have used non-specific measures of emphysema.
The Multi-Ethnic Study of Atherosclerosis Lung Study invited participants recruited from the community without renal impairment to undergo contrast-enhanced dual-energy CT. Pulmonary blood volume was calculated by material decomposition; PMBV was defined as blood volume in the peripheral 2 cm of the lung. Non-contrast CT was acquired to assess per cent emphysema and novel CT emphysema subtypes, which include the diffuse emphysema subtype and small-airways-related combined bronchitic-apical emphysema subtype. Generalised linear regression models included age, sex, race/ethnicity, body size, smoking, total lung volume and small airway count.
Among 495 participants, 53% were never-smokers and the race/ethnic distribution was 35% white, 31% black, 15% Hispanic and 18% Asian. Mean PMBV was 352±120 mL; mean per cent emphysema was 4.95±4.75%. Lower PMBV was associated with greater per cent emphysema (-0.90% per 100 mL PMBV, 95% CI: -1.29 to -0.51). The association was of larger magnitude in participants with 10 or more pack-years smoking and airflow obstruction, but present among participants with no smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype (-1.48% per 100 mL PMBV, 95% CI: -2.31 to -0.55).
In this community-based study, lower PMBV was associated with greater per cent emphysema, including in participants without a smoking history or airflow limitation, and was specific to the diffuse CT emphysema subtype.
肺微血管改变与肺气肿的发病机制有关，但肺微血管血容量（PMBV）与肺气肿之间的关联尚未大规模直接评估，且既往研究使用的是肺气肿的非特异性指标。
动脉粥样硬化多民族肺研究邀请社区招募的无肾功能损害参与者接受对比增强双能CT检查。通过物质分解计算肺血容量；PMBV定义为肺周边2厘米范围内的血容量。采集非对比CT以评估肺气肿百分比和新型CT肺气肿亚型，包括弥漫性肺气肿亚型和与小气道相关的合并支气管炎-顶端肺气肿亚型。广义线性回归模型纳入了年龄、性别、种族/族裔、体型、吸烟情况、肺总量和小气道数量。
495名参与者中，53%为从不吸烟者，种族/族裔分布为35%白人、31%黑人、15%西班牙裔和18%亚裔。平均PMBV为352±120毫升；平均肺气肿百分比为4.95±4.75%。较低的PMBV与较高的肺气肿百分比相关（每100毫升PMBV降低0.90%，95%置信区间：-1.29至-0.51）。在吸烟史10包年及以上且有气流受限的参与者中，这种关联更为显著，但在无吸烟史或气流受限的参与者中也存在，且特定于弥漫性CT肺气肿亚型（每100毫升PMBV降低1.48%，95%置信区间：-2.31至-0.55）。
在这项基于社区的研究中，较低的PMBV与较高的肺气肿百分比相关，包括在无吸烟史或气流受限的参与者中，且特定于弥漫性CT肺气肿亚型。
