Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study
Pulmonary Emphysema Subtypes on Computed Tomography: The MESA COPD Study
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DOI：
10.1016/j.amjmed.2013.09.020
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发表时间：
2014-01-01
影响因子：
5.9
通讯作者：
Barr, R. Graham
中科院分区：
文献类型：
--
作者：
Smith, Benjamin M.;Austin, John H. M.;Barr, R. Graham
背景：肺气肿在尸检中分为3个主要亚型：小叶中心型、隔旁型和全小叶型肺气肿。这些亚型可以通过计算机断层扫描（CT）的视觉评估来定义;然而，CT上肺气肿亚型的临床特征尚未明确。我们开发了一种可靠的方法来直观评估肺气肿亚型的CT和检查肺气肿亚型是否有不同的characteristics.METHODS：多种族研究的动脉粥样硬化COPD研究招募吸烟者慢性阻塞性肺疾病（COPD）和对照组年龄在50-79岁，>= 10包年。参与者按照标准化方案进行CT检查。通过文献回顾获得小叶中心性、间隔旁性和全小叶性肺气肿的定义。六分钟步行距离和肺功能进行以下guidelines.Results：27%的318吸烟者有肺气肿的CT。肺气肿亚型的评定者间信度显著（K：0.70）。与无肺气肿的受试者相比，小叶中心型或全小叶型肺气肿的受试者有更严重的呼吸困难、行走距离缩短、过度充气更严重和弥散功能降低。相比之下，间隔旁肺气肿的个体与对照组相似，除了男性占优势。小叶中心型肺气肿，而不是全小叶或间隔旁型肺气肿，与更大的吸烟史相关（+21包年P
BACKGROUND: Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics.METHODS: The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with >= 10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines.RESULTS: Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P