Morphological changes in small pulmonary vessels are associated with severe acute exacerbation in chronic obstructive pulmonary disease.
Morphological changes in small pulmonary vessels are associated with severe acute exacerbation in chronic obstructive pulmonary disease.
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DOI：
10.2147/copd.s107424
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发表时间：
2016
影响因子：
2.8
通讯作者：
Suda T
中科院分区：
文献类型：
--
作者：
Yoshimura K;Suzuki Y;Uto T;Sato J;Imokawa S;Suda T
肺血管重构是了解慢性阻塞性肺疾病（COPD）发病机制的基础。据报道，肺小血管的总横截面积（CSA）与肺动脉压相关，该技术已能够评估肺血管受累。我们研究了肺血管形态学改变对COPD严重急性加重（AE-COPD）的影响。该研究招募了81名COPD患者和28名非COPD受试者作为对照，并评估了高分辨率计算机断层扫描图像上小于5 mm 2（%CSA <5）和5 - 10 mm 2范围内（%CSA 5 - 10）的CSA百分比（%CSA）。与非COPD受试者相比，COPD患者的%CSA <5。% CSA <5与气流受限呈正相关，与肺气肿程度呈负相关。% CSA <5的COPD患者显示严重AE-COPD的发生率显著增加（Gray检验; P = 0.011）。此外，较低的%CSA <5与重度AE-COPD显著相关（风险比，2.668; 95%置信区间，1.225 - 5.636; P = 0.010）。% CSA <5与重度AE-COPD风险增加相关。肺小血管远端修剪是AE-COPD相关风险的一部分，%CSA <5可能是预测AE-COPD的替代指标。
Pulmonary vascular remodeling is essential for understanding the pathogenesis of chronic obstructive pulmonary disease (COPD). The total cross-sectional area (CSA) of small pulmonary vessels has been reported to correlate with the pulmonary artery pressure, and this technique has enabled the assessment of pulmonary vascular involvements. We investigated the contribution of morphological alterations in the pulmonary vessels to severe acute exacerbation of COPD (AE-COPD). This study enrolled 81 patients with COPD and 28 non-COPD subjects as control and assessed the percentage of CSA (%CSA) less than 5 mm2 (%CSA<5) and %CSA in the range of 5–10 mm2 (%CSA5–10) on high-resolution computed tomography images. Compared with the non-COPD subjects, the COPD patients had lower %CSA<5. %CSA<5 was positively correlated with airflow limitation and negatively correlated with the extent of emphysema. COPD patients with lower %CSA<5 showed significantly increased incidences of severe AE-COPD (Gray’s test; P=0.011). Furthermore, lower %CSA<5 was significantly associated with severe AE-COPD (hazard ratio, 2.668; 95% confidence interval, 1.225–5.636; P=0.010). %CSA<5 was associated with an increased risk of severe AE-COPD. The distal pruning of the small pulmonary vessels is a part of the risk associated with AE-COPD, and %CSA<5 might be a surrogate marker for predicting AE-COPD.