Disease Severity Dependence of the Longitudinal Association Between CT Lung Density and Lung Function in Smokers
Disease Severity Dependence of the Longitudinal Association Between CT Lung Density and Lung Function in Smokers
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DOI：
10.1016/j.chest.2017.10.012
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发表时间：
2018-03-01
期刊：
影响因子：
9.6
通讯作者：
Washko, George R.
中科院分区：
文献类型：
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作者：
Diaz, Alejandro A.;Strand, Matthew;Washko, George R.
背景技术背景：在吸烟者中，肺实质的特征在于炎症和肺气肿，这些过程可导致肺组织的局部获得和损失。CT测量肺密度可能反映肺组织的变化，然而，纵向数据CT肺组织对FEV 1的影响，吸烟者和不吸烟的COPD是稀缺的。方法：CT肺密度的第15百分位数是从扫描的3,390名吸烟者完成基线和5年随访的COPD遗传流行病学（COPDGene）研究访问。使用多变量混合模型评估了总肺容量调整的肺密度（TLC-PD 15）与FEV 1之间的纵向关系。根据全球倡议慢性阻塞性肺疾病（GOLD）分期系统，分别在高危吸烟者、保留比率和肺功能受损（PRISm）的吸烟者和COPD吸烟者中进行单独的模型。在PRISm吸烟者中，TLC-PD 15降低1 g/L与FEV 1增加2.8 mL相关（P = 0.02）。相反，在GOLD III至IV COPD吸烟者中，TLC-PD 15降低1 g/L与FEV 1降低4.1 mL相关（P =.002）。结论：TLC-PD 15降低与FEV 1增加或减少相关，具体取决于疾病严重程度。这些关联是GOLD分期特异性的，它们的存在可能会影响未来使用CT肺密度作为肺功能下降的中间研究终点的研究的解释。
BACKGROUND: In smokers, the lung parenchyma is characterized by inflammation and emphysema, processes that can result in local gain and loss of lung tissue. CT measures of lung density might reflect lung tissue changes; however, longitudinal data regarding the effects of CT lung tissue on FEV1 in smokers with and without COPD are scarce.METHODS: The 15th percentile of CT lung density was obtained from the scans of 3,390 smokers who completed baseline and 5-year follow-up of the Genetic Epidemiology of COPD (COPDGene) study visits. The longitudinal relationship between total lung capacity-adjusted lung density (TLC-PD15) and FEV1 was assessed by using multivariable mixed models. Separate models were performed in smokers at risk, smokers with preserved ratio and impaired spirometry (PRISm), and smokers with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging system.RESULTS: The direction of the relationship between lung density and lung function was GOLD stage dependent. In smokers with PRISm, a 1-g/L decrease in TLC-PD15 was associated with an increase of 2.8 mL FEV1 (P =.02). In contrast, among smokers with GOLD III to IV COPD, a 1-g/L decrease in TLC-PD15 was associated with a decrease of 4.1 mL FEV1 (P =.002).CONCLUSIONS: A decline in TLC-PD15 was associated with an increase or decrease in FEV1 depending on disease severity. The associations are GOLD stage specific, and their presence might influence the interpretation of future studies that use CT lung density as an intermediate study end point for a decline in lung function.