Airway morphology and inspiratory flow features in the early stages of Chronic Obstructive Pulmonary Disease.
Airway morphology and inspiratory flow features in the early stages of Chronic Obstructive Pulmonary Disease.
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DOI：
10.1016/j.clinbiomech.2017.11.005
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发表时间：
2019-06
期刊：
影响因子：
--
通讯作者：
Coletti F
中科院分区：
文献类型：
--
作者：
Van de Moortele T;Goerke U;Wendt CH;Coletti F
慢性阻塞性肺疾病（COPD）是世界范围内的主要死亡原因之一。吸入污染物是主要的风险因素，但发病机制和疾病的进展知之甚少。大多数关于疾病发作和轨迹的研究都集中在遗传和分子生物标志物上。在这里，我们调查的作用，气道解剖和随之而来的呼吸流体力学的发展，慢性阻塞性肺病。我们对三组吸烟者（每组18名受试者）的五年纵向研究的CT扫描进行了分段：（i）基线时最小/轻度阻塞，第五年肺功能下降;（ii）基线时最小/轻度阻塞，功能稳定;（iii）五年内肺功能正常和稳定。我们重建了支气管树直到第7代，并且对于每组中的一名受试者，我们在3D打印模型中进行了MRI速度测量。基线时气流阻塞的受试者气道直径较小，儿童与父母直径比较小，长度与直径比较大，分形维数较小。对于肺功能严重下降的受试者，差异更为显著。二次流的特点是横向分散沿着气道被发现是不太强烈的受试者与气流阻塞。这些结果表明，传导气道的形态和吸气流特征与COPD的状态和进展在疾病的早期阶段已经相关。这表明基于成像的生物标志物可以允许疾病进展的症状前诊断。
Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of death worldwide. Inhaled pollutants are the prime risk factor, but the pathogenesis and progression of the diseased is poorly understood. Most studies on the disease onset and trajectory have focused on genetic and molecular biomarkers. Here we investigate the role of the airway anatomy and the consequent respiratory fluid mechanics on the development of COPD. We segmented CT scans from a five-year longitudinal study in three groups of smokers (18 subjects each) having: (i) minimal/mild obstruction at baseline with declining lung function at year five; (ii) minimal/mild obstruction at baseline with stable function, and (iii) normal and stable lung function over the five year period. We reconstructed the bronchial trees up to the 7th generation, and for one subject in each group we performed MRI velocimetry in 3D printed models. The subjects with airflow obstruction at baseline have smaller airway diameters, smaller child-to-parent diameter ratios, larger length-to-diameter ratios, and smaller fractal dimensions. The differences are more significant for subjects that develop severe decline in pulmonary function. The secondary flows that characterize lateral dispersion along the airways are found to be less intense in the subjects with airflow obstruction. These results indicate that morphology of the conducting airways and inspiratory flow features are correlated with the status and progression of COPD already at an early stage of the disease. This suggests that imaging-based biomarkers may allow a pre-symptomatic diagnosis of disease progression.
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