Lung Clearance Index and HRCT are complementary markers of lung abnormalities in young children with CF
Lung Clearance Index and HRCT are complementary markers of lung abnormalities in young children with CF
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DOI：
10.1136/thx.2010.150375
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发表时间：
2011-06-01
期刊：
影响因子：
10
通讯作者：
Stocks, Janet
中科院分区：
文献类型：
--
作者：
Owens, C. M.;Aurora, P.;Stocks, Janet
高分辨率计算机断层扫描（HRCT）是检测早期囊性纤维化（CF）肺部疾病的一种比肺活量测定法或x线平片更敏感的工具，但其与幼儿肺功能其他指标的关系尚未确定。目的1)评估由多次呼吸惰性气体冲洗（MBW）得出的肺清除率指数（LCI）在识别肺部异常方面是否与HRCT一样有效；2)探讨幼年CF患儿HRCT异常与肺活量、体积谱和MBW （LFTs）的关系。方法CF患儿当天行LFTs和容积HRCT检查。健康年龄匹配的对照组接受相同的LFTs，但没有HRCT。扫描是匿名的，并使用Brody-II CT评分系统评分，以评估支气管扩张、气道壁增厚、粘液堵塞和实质混浊的存在和程度。结果对60例CF患儿（平均（SD） 7.8（1.3）岁）和54例健康对照（7.9 (1.2)y）进行了评估。在CF患儿中，84%（47/56）的LCI异常，58%（27/47）的容积图异常（FRCpleth或RV）， 35%（21/60）的sRaw异常，47%（28/60）的肺活量异常（FEV1或FEF25-75）；而HRCT扫描异常率为85% (51/60)；Brody-II总评分中位数为9.5%（范围0-51%）。相比肺活量（R=-0.43）或其他肺功能指标，CT总评分与LCI的相关性更强（Spearman相关=0.77）。在9名LCI正常的儿童中，5名HRCT显示异常，而5名HRCT正常的儿童LCI升高。这些结果表明，LCI和HRCT在检测CF肺部疾病方面具有相似的敏感性，但在个体患者中可能获得互补信息。
Rationale High resolution computed tomography (HRCT) is a more sensitive tool for detecting early cystic fibrosis (CF) lung disease than either spirometry or plain radiography, but its relationship to other measures of lung function has not been established in young children.Objectives 1) To assess whether the lung clearance index (LCI) derived from multiple breath inert-gas washout (MBW) is as effective as HRCT in identifying pulmonary abnormalities; and 2) explore the relationships between abnormalities detected by HRCT and by spirometry, plethysmography and MBW (collectively, LFTs) in young children with CF.Methods Children with CF underwent LFTs and volumetric HRCT on the same day. Healthy age-matched controls underwent identical LFTs without HRCT. Scans were anonymised, and scored using the Brody-II CT scoring system, to assess for presence and extent of bronchiectasis, airway wall thickening, mucus plugging, and parenchymal opacities.Results Assessments were undertaken in 60 children with CF (mean (SD) 7.8 (1.3) years) and 54 healthy controls (7.9 (1.2) y). Among children with CF, 84% (47/56) had abnormal LCI, 58% (27/47) abnormal plethysmographic lung volumes (FRCpleth or RV), 35% (21/60) abnormal sRaw and 47% (28/60) abnormal spirometry (FEV1 or FEF25-75); whereas HRCT scans were abnormal in 85% (51/60): median total Brody-II score: 9.5% (range 0-51%). Total CT score correlated more strongly with LCI (Spearman correlation=0.77) than with spirometry (R=-0.43) or any other marker of lung function. Of the nine children with normal LCI, five had abnormalities on HRCT, whereas five children with normal HRCT had raised LCI.Conclusions These results suggest that while LCI and HRCT have similar sensitivity to detect CF lung disease, complimentary information may be gained in individual patients.