Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis
Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis
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DOI：
10.1378/chest.130.5.1424
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发表时间：
2006-11-01
期刊：
影响因子：
9.6
通讯作者：
Gallagher, Charles G.
中科院分区：
文献类型：
--
作者：
Judge, Eoin P.;Dodd, Jonathan D.;Gallagher, Charles G.
背景：囊性纤维化(CF)患儿的FEV1可能保持稳定，而高分辨率CT(HRCT)表现恶化。然而，肺活量测定结果在年龄较大的人群中普遍下降。目的：比较成人队列中HRCT异常率和肺活量测定结果随时间的下降速度。方法：连续39例患者(男性19例，女性20例；平均年龄22岁；年龄16-48岁)进行了两次HRCT扫描，由两名独立的胸部放射科医生使用改良的Bhala评分系统进行随机盲法评分。记录两次HRCT时的年龄、体重指数、肺活量测定和痰培养。结果：FEV1平均每年下降-2.3%，HRCT总分平均每年下降-2.7%。几个单独的HRCT异常以及HRCT总分下降的速度明显快于FEV1(p<；0.001)。6名患者的肺活量测定结果稳定，但HRCT评分恶化。在肺功能轻度受损的组中，粘液堵塞和支气管扩张的程度恶化的速度更快。在中重度肺功能受损的患者中，空气滞留、塌陷/固结、支气管周增厚、严重的支气管扩张和多代支气管炎恶化的速度更快。结论：成人CF患者HRCT异常的下降率快于肺活量测定结果。根据肺功能受损程度的不同，个体HRCT异常率下降的速度也不同。
Background: FEV1 may remain stable while high-resolution CT (HRCT) appearances deteriorate in children with cystic fibrosis (CF). However, spirometry results commonly decline in older age groups.Objectives: To compare the rate of decline in HRCT abnormalities and spirometry results over time in an adult cohort with CF.Methods: The HRCT scans of 39 consecutive patients (19 males and 20 females; mean age, 22 years; range, 16 to 48 years) with two HRCT scans > 18 months apart were randomly and blindly scored using a modified Bhalla scoring system by two independent chest radiologists. Age, body mass index, spirometry, and sputum cultures were recorded at the time of both HRCTs. Rates of change in clinical parameters and HRCT abnormalities were calculated and compared using repeated-measures analysis of variance.Results: Mean FEV1 declined at a rate of -2.3% per year, while mean HRCT total score declined at a rate of -2.7% per year. Several individual HRCT abnormalities as well as HRCT total scores declined significantly faster than FEV1 (p < 0.001). Six patients showed stable spirometry results but worsening HRCT scores. Mucus plugging and extent of bronchiectasis deteriorated at a more rapid rate in the group with mildly impaired lung function. Air trapping, collapse/consolidation, peribronchial thickening, severity of bronchiectasis, and generations of bronchial divisions involved deteriorated at a more rapid rate in the group with moderate-to-severely impaired lung function.Conclusions: Adult CF patients have more rapid rates of decline in HRCT abnormalities than in spirometry results. Individual HRCT abnormalities decline at different rates depending on the degree of lung function impairment.