Central airway and peripheral lung structures in airway disease-dominant COPD
Central airway and peripheral lung structures in airway disease-dominant COPD
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DOI：
10.1183/23120541.00672-2020
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发表时间：
2021-01-01
影响因子：
4.6
通讯作者：
Hirai, Toyohiro
中科院分区：
文献类型：
--
作者：
Tanabe, Naoya;Shimizu, Kaoruko;Hirai, Toyohiro
小气道是所有COPD表型的主要病理部位的概念受到了最近发现的挑战，该发现表明，在COPD亚组中，疾病始于中央气道，较小的中央气道树增加了COPD风险。本研究旨在检查与肺气肿显性（艾德）亚型相比，基于计算机断层扫描（CT）的气道疾病显性（AD）亚型（使用中心气道尺寸定义）是否与CT上的小气道功能障碍（SAD）相关性较小。艾德和混合组基于节段气道的壁面积百分比（WA%）和Kyoto-Himeji（n=189）和北海道COPD队列（n=93）中的低衰减容积百分比。SAD区体积百分比（SAD%）由吸气和呼气CT非刚性配准获得，AD组SAD%低于艾德组，与轻度组相似。与艾德组相比，AD组近段气道管腔较小，40岁以前哮喘史较多。在多变量分析中，虽然AD和艾德组类似地与更大的气流限制相关，但艾德组而非AD组与更大的SAD%相关，而AD组而非艾德组与更小的中心气道尺寸相关。基于CT的AD COPD亚型可能与更小的中心气道树和哮喘病史相关，但与艾德亚型不同，其不具有包括小气道疾病在内的外周肺病变。
The concept that the small airway is a primary pathological site for all COPD phenotypes has been challenged by recent findings that the disease starts from the central airways in COPD subgroups and that a smaller central airway tree increases COPD risk. This study aimed to examine whether the computed tomography (CT)-based airway disease-dominant (AD) subtype, defined using the central airway dimension, was less associated with small airway dysfunction (SAD) on CT, compared to the emphysema-dominant (ED) subtype.COPD patients were categorised into mild, AD, ED and mixed groups based on wall area per cent (WA%) of the segmental airways and low attenuation volume per cent in the Kyoto-Himeji (n=189) and Hokkaido COPD cohorts (n=93). The volume per cent of SAD regions (SAD%) was obtained by nonrigidly registering inspiratory and expiratory CT.The AD group had a lower SAD% than the ED group and similar SAD% to the mild group. The AD group had a smaller lumen size of airways proximal to the segmental airways and more frequent asthma history before age 40 years than the ED group. In multivariable analyses, while the AD and ED groups were similarly associated with greater airflow limitation, the ED, but not the AD, group was associated with greater SAD%, whereas the AD, but not the ED, group was associated with a smaller central airway size.The CT-based AD COPD subtype might be associated with a smaller central airway tree and asthma history, but not with peripheral lung pathologies including small airway disease, unlike the ED subtype.