Idiopathic pulmonary fibrosis - A composite physiologic index derived from disease extent observed by computed tomography
Idiopathic pulmonary fibrosis - A composite physiologic index derived from disease extent observed by computed tomography
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DOI：
10.1164/rccm.2111053
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发表时间：
2003-04-01
影响因子：
24.7
通讯作者：
Hansell, DM
中科院分区：
文献类型：
--
作者：
Wells, AU;Desai, SR;Hansell, DM
在特发性肺纤维化中，肺功能测试对疾病严重程度的量化常常会被肺气肿所混淆。我们确定了最能反映肺纤维化形态程度的综合生理指数(CPI)。连续的临床/CT诊断为特发性肺纤维化的患者(n=212)分为I组(n=106)和II组(n=106)。I组(肺功能试验与CT上的病变范围进行拟合)计算CPI，IT组测定CPI。CPI的公式如下：CT上的疾病程度=91.0-(0.65X预测一氧化碳弥散量[DLCO])-(0.53X预测FVC)+(0.34X预测FEV1)。在II组中，CT上CPI与病情严重程度的相关性(r(2)=0.51)明显高于个体肺功能检查(DLCO最高值，r(2)=0.38)。一项子分析表明，CPI的更好适合性可归因于肺气肿混杂影响的纠正。在所有临床亚组中，包括组织学证实的普通型间质性肺炎(CPI，P<；0.0005；FVC，P-0.002；Po-2，P 0.002)的单独队列患者，CPI对死亡率的预测比肺功能测试更准确。总而言之，根据CT得出的新的CPI，并通过分裂样本测试进行验证，是普通间质性肺炎比个体肺功能测试更准确的预后决定因素。
In idiopathic pulmonary fibrosis, the quantitation of disease severity using pulmonary function tests is often confounded by emphysema. We have identified the composite physiologic index (CPI) most closely reflecting the morphologic extent of pulmonary fibrosis. Consecutive patients with a clinical/computed tomography (CT) diagnosis of idiopathic pulmonary fibrosis (n = 212) were divided into group I (n = 106) and group II (n = 106). The CPI was derived in group I (by fitting pulmonary function tests against disease extent on CT) and was tested in Group It. The formula for the CPI was as follows: extent of disease on CT = 91.0 - (0.65 X percent predicted diffusing capacity for carbon monoxide [DLCO]) - (0.53 X percent predicted FVC) + (0.34 x percent predicted FEV1). In group II, the CPI correlated more strongly with disease extent on CT (r(2) = 0.51) than the individual pulmonary function test (DLCO the highest value, r(2) = 0.38). A subanalysis demonstrated that the better fit of the CPI was ascribable to a correction of the confounding effects of emphysema. Mortality was predicted more accurately by the CPI than by a pulmonary function test in all clinical subgroups, including a separate cohort of 36 patients with histologically proven usual interstitial pneumonia (CPI, p < 0.0005; FVC, p - 0.002; Po-2, P 0.002). In conclusion, a new CPI, derived against CT and validated using split sample testing, is a more accurate prognostic determinant in usual interstitial pneumonia than an individual pulmonary function test.