Residual volume/total lung capacity ratio confers limited additive significance to lung clearance index for assessment of adults with bronchiectasis.
Residual volume/total lung capacity ratio confers limited additive significance to lung clearance index for assessment of adults with bronchiectasis.
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DOI：
10.1371/journal.pone.0183779
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Zhong NS
中科院分区：
文献类型：
--
作者：
Guan WJ;Yuan JJ;Huang Y;Li HM;Chen RC;Zhong NS
嵌合和过度充气是支气管扩张的常见病理生理特征。通气不均匀性的大小可能受到恶性通货膨胀程度的影响。一些研究评估了肺清除指数（LCI）在支气管扩张患者中的判别性能，但恶性通货膨胀指标对 LCI 的附加诊断价值尚不清楚。旨在比较成人支气管扩张症患者的 LCI 和残气量与总肺容量 (RV/TLC) 的比率，以及用 RV/TLC 标准化的 LCI，以区别性能、与临床变量的相关性和一致性。测量项目包括胸部高分辨率计算机断层扫描、多次呼吸氮冲洗试验、肺活量测定和痰培养。我们根据中位水平（LCIHigh/RV/TLCHigh、LCILow/RV/TLCHigh、LCIHigh/RV/TLCLow 和 LCILow/RV/TLCLow）对 LCI 和 RV/TLC 进行分层来分析支气管扩张剂反应。对 127 名临床稳定支气管扩张症成人的数据进行了分析。 LCI 在区分中重度和轻度支气管扩张方面比 RV/TLC 具有更大的诊断价值，在反映临床特征（包括支气管扩张叶的数量、放射学严重程度评分和囊性支气管扩张的存在）方面具有更大的一致性。使用 RV/TLC 对 LCI 进行标准化并不能提高区分性能或与临床变量的一致性。 RV/TLC 标准化前后的 LCI 与年龄、性别、HRCT 评分、铜绿假单胞菌定植、囊性支气管扩张和通气异质性具有统计学相关性（均 P<0.05）。支气管扩张患者的四个亚组（包括 LCI 和 RV/TLC 水平不一致的患者）中，不同的支气管扩张剂反应并不显着。对于支气管扩张评估，LCI 优于 RV/TLC。不需要用 RV/TLC 进行标准化。 LCI 和 RV/TLC 的分层与显着不同的支气管扩张剂反应无关。
Mosaicism and hyperinflation are common pathophysiologic features of bronchiectasis. The magnitude of ventilation heterogeneity might have been affected by the degree of hyperinflation. Some studies have evaluated the discriminative performance of lung clearance index (LCI) in bronchiectasis patients, but the additive diagnostic value of hyperinflation metrics to LCI is unknown. To compare LCI and the ratio of residual volume to total lung capacity (RV/TLC), along with the LCI normalized with RV/TLC, in terms of discriminative performance, correlation and concordance with clinical variables in adults with bronchiectasis. Measurement items included chest high-resolution computed tomography, multiple-breath nitrogen washout test, spirometry, and sputum culture. We analyzed bronchodilator responses by stratifying LCI and RV/TLC according to their median levels (LCIHigh/RV/TLCHigh, LCILow/RV/TLCHigh, LCIHigh/RV/TLCLow, and LCILow/RV/TLCLow). Data from 127 adults with clinically stable bronchiectasis were analyzed. LCI had greater diagnostic value than RV/TLC in discriminating moderate-to-severe from mild bronchiectasis, had greater concordance in reflecting clinical characteristics (including the number of bronchiectatic lobes, radiological severity score, and the presence of cystic bronchiectasis). Normalization of LCI with RV/TLC did not contribute to greater discriminative performance or concordance with clinical variables. The LCI, before and after normalization with RV/TLC, correlated statistically with age, sex, HRCT score, Pseudomonas aeruginosa colonization, cystic bronchiectasis, and ventilation heterogeneity (all P<0.05). Different bronchodilator responses were not significant among the four subgroups of bronchiectasis patients, including those with discordant LCI and RV/TLC levels. LCI is superior to RV/TLC for bronchiectasis assessment. Normalization with RV/TLC is not required. Stratification of LCI and RV/TLC is not associated with significantly different bronchodilator responses.
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