Influence of Emphysema and Air Trapping Heterogeneity on Pulmonary Function in Patients with COPD
Influence of Emphysema and Air Trapping Heterogeneity on Pulmonary Function in Patients with COPD
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DOI：
10.2147/copd.s221684
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发表时间：
2019-01-01
影响因子：
2.8
通讯作者：
Jiang, Tao
中科院分区：
文献类型：
--
作者：
Li, Kun;Gao, Yanli;Jiang, Tao
目的：探讨肺气肿和空气滞留异质性对稳定期慢性阻塞性肺疾病（COPD）患者肺功能变化的影响。患者和方法：本前瞻性研究纳入了 179 名稳定期 COPD 患者。所有患者均接受低剂量吸气和呼气 CT 扫描以及肺功能测试。测量全肺、右肺、左肺以及头尾肺区域的全吸气时的肺气肿指数（EI）和全呼气时的空气滞留（AT）的CT定量数据。肺气肿和空气滞留的异质性指数（HI）值被确定为差值与各指数之和的比率。比较轻至中度（GOLD I 期和 II 期）和重度（GOLD III 期和 IV 期）疾病组的头尾 HI 和左右肺 HI。使用多元线性回归分析评估根据年龄、性别、身高、吸烟史、EI 和全肺 AT 调整后的 HI 和肺功能测量值之间的关联。结果：完全呼气时头尾 HI (AT_CC_HI) 和左右肺 HI (AT_LR_HI) 的绝对值在轻度至中度组中显着更大，而完全吸气时没有观察到显着的组间差异。下区和/或左肺为主的 COPD 患者在完全呼气时的肺功能显着低于上区和/或右肺为主的患者，而在完全吸气时没有观察到显着差异。 AT_CC_HI 和 AT_LR_HI 的绝对值与肺功能测量值显着相关。在调整了年龄、性别、身高、吸烟史、全肺的 EI 和 AT 后，较高的 AT_CC_HI 和较低的 AT_LR_HI 绝对值表明肺功能较好。结论：完全呼气时分布更不均匀和/或上区为主和/或右肺为主模式的受试者往往具有更好的肺功能。因此，与肺气肿异质性相比，AT异质性更能反映COPD患者肺功能的变化。
Purpose: To explore the influence of emphysema and air trapping heterogeneity on pulmonary function changes in patients with stable chronic obstructive pulmonary disease (COPD).Patients and methods: One hundred and seventy-nine patients with stable COPD were enrolled in this prospective study. All patients underwent low-dose inspiratory and expiratory CT scanning and pulmonary-function tests. CT quantitative data for the emphysema index (EI) on full-inspiration and air trapping (AT) on full-expiration were measured for the whole lung, the right and left lungs, and the cranial-caudal lung zones. The heterogeneity index (HI) values for emphysema and air trapping were determined as the ratio of the difference to the sum of the respective indexes. The cranial-caudal HI and left-right lung HI were compared between mild-to-moderate (GOLD stage I and II) and severe (GOLD stage III and IV) disease groups. The associations between HI and pulmonary-function measurements adjusted for age, sex, height, smoking history, EI and AT of the total lung were assessed using multiple linear regression analysis.Results: The absolute values for cranial-caudal HI (AT_CC_HI) and left-right lung HI (AT_LR_HI) on full-expiration were significantly larger in the mild-to-moderate group, while no significant intergroup differences were observed on full-inspiration. COPD patients with lower-zone and/or left-lung predominance showed significantly lower pulmonary function than those with upper-zone and/or right-lung predominance on full-expiration, whereas no significant differences were observed on full-inspiration. The absolute values of AT_CC_HI and AT_LR_HI significantly correlated with pulmonary-function measurements. Higher AT_CC_HI and lower AT_LR_HI absolute values indicated better pulmonary function, after adjusting for age, sex, height, smoking history, EI and AT of the total lung.Conclusion: Subjects with more heterogeneous distribution and/or upper-zone predominant and/or right-lung predominant patterns on full-expiration tend to have better pulmonary function. Thus, in comparison with emphysema heterogeneity, AT heterogeneity better reflects the pulmonary function changes in COPD patients.