Distribution of Early Structural Lung Changes due to Cystic Fibrosis Detected with Chest Computed Tomography
Distribution of Early Structural Lung Changes due to Cystic Fibrosis Detected with Chest Computed Tomography
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DOI：
10.1016/j.jpeds.2012.12.042
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发表时间：
2013-07-01
影响因子：
5.1
通讯作者：
Stick, Stephen M.
中科院分区：
文献类型：
--
作者：
Mott, Lauren S.;Park, Judy;Stick, Stephen M.
目的探讨早期结构性肺变化的分布在临床稳定的婴儿和幼儿囊性纤维化使用胸部CT（CT）Study design这一横断面研究包括62名儿童年龄1-6岁的体积控制容积胸部CT扫描全麻下进行的早期监测计划的一部分。使用半定量评分对每个肺叶的支气管扩张、粘液堵塞和空气滞留的存在和程度进行评分。结构异常的地形分布进行了评估，通过比较不同的肺区域和检查组件之间的关系的异常的存在和程度。结果虽然支气管扩张是最常见的右上叶，肺结构的整体变化并不常见或更广泛的上叶。相反，支气管扩张在右肺更常见（右肺0.95，左肺0.68，P = 0.003），粘液堵塞（上0.41，中0.41，下0.72，P = 0.028）和空气潴留（上0.79，中0.48，下0.96，P <0.001）在下叶更常见。右肺的支气管扩张（P < .001）和空气滞留（P = .011）程度更大。支气管扩张的肺扫描也更可能同时存在粘液阻塞（P = 0.008）和空气潴留（P <0.001）。使用胸部CT作为终点的研究的定量评分工具，以及寻求更好地了解早期囊性纤维化肺疾病发病机制的机制研究，应考虑到这种早期疾病的差异地形图表达。
Objective To examine the distribution of early structural lung changes in clinically stable infants and young children with cystic fibrosis using chest computed tomography (CT).Study design This cross-sectional study included 62 children aged 1-6 years with volume-controlled volumetric chest CT scans performed under general anesthesia as part of an early surveillance program. Each lobe was scored for presence and extent of bronchiectasis, mucus plugging, and air trapping using a semiquantitative score. The topographic distribution of structural abnormalities was evaluated by comparing the presence and extent of abnormalities in different lung regions and examining relationships between components.Results Although bronchiectasis was most common in the right upper lobe, overall changes in lung structure were not more common or more extensive in the upper lobes. Rather, bronchiectasis was more common in the right lung (right lung 0.95, left lung 0.68, P = .003), and mucus plugging (upper 0.41, middle 0.41, lower 0.72, P = .028) and air trapping (upper 0.79, middle 0.48, lower 0.96, P < .001) were more common in the lower lobes. The extents of bronchiectasis (P < .001) and air trapping (P = .011) were greater in the right lung. Scans with bronchiectasis were also more likely to have coexisting mucus plugging (P = .008) and air trapping (P < .001).Conclusion Early structural lung disease is heterogeneously distributed in the lung. Quantitative scoring tools for studies using chest CT as an end point, and mechanistic studies that seek to better understand the pathogenesis of early cystic fibrosis lung disease, should take account of this differential topographic expression of disease early in life.