Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
Mucus Plugs and Emphysema in the Pathophysiology of Airflow Obstruction and Hypoxemia in Smokers
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DOI：
10.1164/rccm.202006-2248oc
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发表时间：
2021-04-15
影响因子：
24.7
通讯作者：
Fahy, John, V
中科院分区：
文献类型：
--
作者：
Dunican, Eleanor M.;Elicker, Brett M.;Fahy, John, V
基本原理：在慢性阻塞性肺疾病（COPD）吸烟者中，粘液栓和肺气肿在气流受限和低氧血症机制中的相对作用尚不确定。目的：将基于图像的粘液栓和肺气肿测量与COPD患者的气流阻塞和氧合测量相关联。方法：我们分析了COPD研究中亚群和中间结局指标参与者的CT肺部影像和肺功能。放射科医生在CT肺部图像上对粘液栓进行评分，成像软件自动量化肺气肿的百分比。未调整和调整之间的关系粘液栓评分，肺气肿的百分比，肺功能测定使用regression. Measures和主要结果：在400名吸烟者，229（57%）有粘液栓和207（52%）有肺气肿，和亚组可以确定为粘液为主和肺气肿为主的疾病。只有33%的高粘液栓评分的吸烟者有粘液症状。粘液栓评分和肺气肿百分比与FEV 1和外周血氧饱和度的低值独立相关（P < 0.001）。粘液栓评分与肺功能结果之间的关系在吸烟伴局限性肺气肿的患者中最强（P < 0.001）。与粘液栓评分低的吸烟者相比，评分高的吸烟者的COPD评估测试评分更差（17.4 +/- 7.7 vs. 14.4 +/- 13.3），每年加重频率更高（0.75 +/- 1.1 vs. 0.43 +/- 0.85），以及较短的6分钟步行距离（329 +/- 115与392 +/- 117 m）结论：症状性无症状粘液栓在吸烟者中非常普遍，并且与肺功能结果独立相关。这些数据为在粘液活性治疗的临床试验中靶向粘液高/肺气肿低COPD患者提供了依据。临床试验在www.clinicaltrials.gov注册（NCT 01969344）。
Rationale: The relative roles of mucus plugs and emphysema in mechanisms of airflow limitation and hypoxemia in smokers with chronic obstructive pulmonary disease (COPD) are uncertain.Objectives: To relate image-based measures of mucus plugs and emphysema to measures of airflow obstruction and oxygenation in patients with COPD.Methods: We analyzed computed tomographic (CT) lung images and lung function in participants in the Subpopulations and Intermediate OutcomeMeasures inCOPDStudy. Radiologists scoredmucus plugs on CT lung images, and imaging software automatically quantified emphysema percentage. Unadjusted and adjusted relationships between mucus plug score, emphysema percentage, and lung function were determined using regression.Measurements and Main Results: Among 400 smokers, 229 (57%) had mucus plugs and 207 (52%) had emphysema, and subgroups could be identified with mucus-dominant and emphysema-dominant disease. Only33% of smokers with high mucus plug scoreshad mucus symptoms. Mucus plug score and emphysema percentage were independently associated with lower values for FEV1 and peripheral oxygen saturation (P < 0.001). The relationships between mucus plug score and lung function outcomes were strongest in smokers with limited emphysema (P < 0.001). Compared with smokers with low mucus plug scores, those with high scores had worse COPD Assessment Test scores (17.4 +/- 7.7 vs. 14.4 +/- 13.3), more frequent annual exacerbations (0.75 +/- 1.1 vs. 0.43 +/- 0.85), and shorter 6-minute-walk distance (329 +/- 115 vs. 392 +/- 117 m) (P < 0.001).Conclusions: Symptomatically silent mucus plugs are highly prevalent in smokers and independently associate with lung function outcomes. These data provide rationale for targeting patients with mucus-high/emphysema-low COPD in clinical trials of mucoactive treatments.Clinical trial registered with www.clinicaltrials.gov (NCT01969344).