Lung volumes and emphysema in smokers with interstitial lung abnormalities.
Lung volumes and emphysema in smokers with interstitial lung abnormalities.
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DOI：
10.1056/nejmoa1007285
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发表时间：
2011-03-10
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影响因子：
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通讯作者：
COPDGene Investigators
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作者：
Washko GR;Hunninghake GM;Fernandez IE;Nishino M;Okajima Y;Yamashiro T;Ross JC;Estépar RS;Lynch DA;Brehm JM;Andriole KP;Diaz AA;Khorasani R;D'Aco K;Sciurba FC;Silverman EK;Hatabu H;Rosas IO;COPDGene Investigators
吸烟与肺气肿和放射学间质性肺异常有关。间质性肺异常与肺总容量减少和肺气肿程度的相关程度尚不清楚。我们在一组吸烟者的2508例高分辨率计算机断层扫描（HRCT）中的2416例（96%）中寻找间质性肺异常。我们使用线性和逻辑回归来评估间质性肺异常与HRCT测量的总肺容量和肺气肿之间的关系。评价的2416例HRCT扫描中，194例（8%）存在间质性肺异常。在调整相关协变量的统计模型中，间质性肺异常与总肺容量降低相关（-0.444升; 95%置信区间[CI]，-0.596至-0.292; P<0.001），肺气肿的百分比较低，肺衰减阈值为-950 Hounsfield单位（−3%; 95% CI，−4至−2; P<0.001）和−910亨氏单位（−10%; 95% CI，−12至−8; P<0.001）。与无间质性肺异常的受试者相比，有异常的受试者更可能有限制性肺功能缺损（总肺容量<预测值的80%;比值比，2.3; 95%CI，1.4至3.7; P<0.001），并且不太可能符合慢性阻塞性肺疾病（COPD）的诊断标准。（比值比，0.53; 95%CI，0.37至0.76; P<0.001）。间质性肺异常对总肺容量和肺气肿的影响取决于COPD状态（相互作用P<0.02）。间质性肺异常与烟草烟雾暴露和当前吸烟呈正相关。在吸烟者中，间质性肺异常-每12次HRCT扫描中约有1次出现-与总肺容量减少和肺气肿量减少有关。（由美国国立卫生研究院和帕克B。弗朗西斯基金会; ClinicalTrials.gov编号，NCT 00608764。）
Cigarette smoking is associated with emphysema and radiographic interstitial lung abnormalities. The degree to which interstitial lung abnormalities are associated with reduced total lung capacity and the extent of emphysema is not known. We looked for interstitial lung abnormalities in 2416 (96%) of 2508 high-resolution computed tomographic (HRCT) scans of the lung obtained from a cohort of smokers. We used linear and logistic regression to evaluate the associations between interstitial lung abnormalities and HRCT measurements of total lung capacity and emphysema. Interstitial lung abnormalities were present in 194 (8%) of the 2416 HRCT scans evaluated. In statistical models adjusting for relevant covariates, interstitial lung abnormalities were associated with reduced total lung capacity (−0.444 liters; 95% confidence interval [CI], −0.596 to −0.292; P<0.001) and a lower percentage of emphysema defined by lung-attenuation thresholds of −950 Hounsfield units (−3%; 95% CI, −4 to −2; P<0.001) and −910 Hounsfield units (−10%; 95% CI, −12 to −8; P<0.001). As compared with participants without interstitial lung abnormalities, those with abnormalities were more likely to have a restrictive lung deficit (total lung capacity <80% of the predicted value; odds ratio, 2.3; 95% CI, 1.4 to 3.7; P<0.001) and were less likely to meet the diagnostic criteria for chronic obstructive pulmonary disease (COPD) (odds ratio, 0.53; 95% CI, 0.37 to 0.76; P<0.001). The effect of interstitial lung abnormalities on total lung capacity and emphysema was dependent on COPD status (P<0.02 for the interactions). Interstitial lung abnormalities were positively associated with both greater exposure to tobacco smoke and current smoking. In smokers, interstitial lung abnormalities — which were present on about 1 of every 12 HRCT scans — were associated with reduced total lung capacity and a lesser amount of emphysema. (Funded by the National Institutes of Health and the Parker B. Francis Foundation; ClinicalTrials.gov number, NCT00608764.)