Air trapping on chest CT is associated with worse ventilation distribution in infants with cystic fibrosis diagnosed following newborn screening.
Air trapping on chest CT is associated with worse ventilation distribution in infants with cystic fibrosis diagnosed following newborn screening.
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DOI：
10.1371/journal.pone.0023932
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Simpson S
中科院分区：
文献类型：
--
作者：
Hall GL;Logie KM;Parsons F;Schulzke SM;Nolan G;Murray C;Ranganathan S;Robinson P;Sly PD;Stick SM;AREST CF;Berry L;Garratt L;Massie J;Mott L;Poreddy S;Simpson S
在患有囊性纤维化(CF)的学龄儿童中，胸部CT评估的结构性肺损伤与异常的通风分布有关。这项分析的主要目的是确定呼吸分配结果与胸部CT评估的结构损伤的存在和程度之间的关系。对2005年8月至2009年12月期间连续复习的新生儿筛查后确诊为CF的婴幼儿的资料进行了分析。在诊断时和之后每年测定肺通气量分布(肺清除指数和一、二阶矩比值[LCI，M1/M0和M2/M0])、胸部CT和支气管肺泡灌洗所得的呼吸道病理。胸部CT扫描评估有无支气管扩张和空气滞留。49名婴儿(31名男性)的肺功能、胸部CT和病理结果相匹配，其中13名(27%)出现了支气管扩张，24名(49%)出现了空气滞留。出现支气管扩张或空气滞留与M2/M0增加有关，但与LCI或M1/M0无关。空气滞留的程度与所有通风分配结果之间存在微弱的、但在统计学上显著的关联。这些发现表明，在早期的CF肺疾病中，胸部CT所显示的肺损伤与通气量分布之间的相关性较弱。这些发现与年龄较大的儿童的研究结果形成了鲜明对比。这些发现表明，在生命的头两年，LCI的评估不能取代胸部CT扫描来评估结构性肺部疾病。在获得MBW和胸部CT结果的进一步研究中，需要评估通气量分布在追踪CF型婴儿肺损伤进展中的作用。
In school-aged children with cystic fibrosis (CF) structural lung damage assessed using chest CT is associated with abnormal ventilation distribution. The primary objective of this analysis was to determine the relationships between ventilation distribution outcomes and the presence and extent of structural damage as assessed by chest CT in infants and young children with CF. Data of infants and young children with CF diagnosed following newborn screening consecutively reviewed between August 2005 and December 2009 were analysed. Ventilation distribution (lung clearance index and the first and second moment ratios [LCI, M1/M0 and M2/M0, respectively]), chest CT and airway pathology from bronchoalveolar lavage were determined at diagnosis and then annually. The chest CT scans were evaluated for the presence or absence of bronchiectasis and air trapping. Matched lung function, chest CT and pathology outcomes were available in 49 infants (31 male) with bronchiectasis and air trapping present in 13 (27%) and 24 (49%) infants, respectively. The presence of bronchiectasis or air trapping was associated with increased M2/M0 but not LCI or M1/M0. There was a weak, but statistically significant association between the extent of air trapping and all ventilation distribution outcomes. These findings suggest that in early CF lung disease there are weak associations between ventilation distribution and lung damage from chest CT. These finding are in contrast to those reported in older children. These findings suggest that assessments of LCI could not be used to replace a chest CT scan for the assessment of structural lung disease in the first two years of life. Further research in which both MBW and chest CT outcomes are obtained is required to assess the role of ventilation distribution in tracking the progression of lung damage in infants with CF.
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