Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography
Clinical analysis of chronic obstructive pulmonary disease phenotypes classified using high-resolution computed tomography
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DOI：
10.1111/j.1440-1843.2006.00930.x
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发表时间：
2006-11-01
期刊：
影响因子：
6.9
通讯作者：
Honda, Takayuki
中科院分区：
文献类型：
--
作者：
Fujimoto, Keisaku;Kitaguchi, Yoshiaki;Honda, Takayuki
目的和背景：方法对172例稳定期COPD患者（FEV 1 < 80%）行胸部高分辨率CT检查，根据肺气肿占优势和支气管壁增厚（BWT）的存在情况，将COPD患者分为不同的表型。对肺气肿变化和BWT进行目视评估，并将COPD患者分为三种表型：无肺气肿、伴有或不伴有BWT的少量肺气肿（A表型）、不伴有BWT的肺气肿（E表型）和伴有BWT表型的肺气肿（M表型）。结果与E表型相比，A表型在从不吸烟者和运动时和休息时喘息患者中的患病率较高，BMI和单碳化合物弥散量（DLCO）值较高，肺部过度充气较轻，对β 2受体激动剂反应的气流限制的可逆性较大。M型COPD患者多痰、排痰、喘息、急性加重或住院率高，β 2受体激动剂对气流受限的可逆性强，而E型COPD患者多痰、排痰、喘息的发生率高。
Objective and background: The present study was performed to clarify the clinical characteristics of patients with COPD classified into phenotypes according to the dominancy of emphysema and the presence of bronchial wall thickening (BWT) evaluated by chest high-resolution CT.Methods A total of 172 patients with stable COPD (FEV1 < 80%) were examined by chest high-resolution CT. Emphysematous changes and BWT were evaluated visually, and COPD patients were classified into three phenotypes: absence of emphysema, with little emphysema with or without BWT (A phenotype), emphysema without BWT (E phenotype) and emphysema with BWT phenotype (M phenotype). The clinical characteristics were compared among the three phenotypes.Results The A phenotype showed a higher prevalence of those who had never smoked and patients with wheezing both on exertion and at rest, higher values of BMI and diffusing capacity for carbon mononide (DLCO), milder lung hyperinflation, and greater reversibility of airflow limitation responsive to beta(2)-agonist as compared with the E phenotype. The M phenotype showed a higher prevalence of patients complaining of a large amount of sputum, productive cough and wheezing, higher rate of exacerbation or hospitalization and greater reversibility of airflow limitation responsive to beta(2)-agonist as compared with the E phenotype.Conclusions These findings suggest that the morphological phenotypes of COPD show several clinical characteristics and different responsiveness to bronchodilators.