Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease.

Relationship between quantitative CT metrics and health status and BODE in chronic obstructive pulmonary disease.
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DOI:
10.1136/thoraxjnl-2011-201185
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发表时间:
2012-05
期刊:
影响因子:
10
通讯作者:
COPDGene Investigators
COPDGene Investigators
中科院分区:
医学1区
文献类型:
--
作者:
Martinez CH;Chen YH;Westgate PM;Liu LX;Murray S;Curtis JL;Make BJ;Kazerooni EA;Lynch DA;Marchetti N;Washko GR;Martinez FJ;Han MK;COPDGene Investigators

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定量计算机断层扫描 (QCT) 在识别慢性阻塞性肺疾病 (COPD) 表型方面的价值日益受到重视。我们假设 QCT 定义的肺气肿和气道异常与圣乔治呼吸问卷 (SGRQ) 和 BODE 相关。纳入了 1,200 名通过 QCT 分析符合 COPD GOLD 标准的 COPDGene 受试者。使用密度掩模技术以-950 HU阈值测量总肺气肿。自动程序测量了六个节段支气管的平均壁厚 (WT)、壁面积百分比 (WA%) 和 pi10。单独的多变量分析检查了气道测量和肺气肿对 SGRQ 和 BODE 的相对影响。在预测 SGRQ 评分的单独模型中,每个气道测量值增加 1 个单位标准差 (SD) 预示着更高的 SGRQ 评分(对于 WT,高 1.90 分,p=0.002;对于 WA%,高 1.52 分,p=0.02;对于 pi10,高 2.83 分,p<0.001)。在这些模型中,肺气肿百分比每增加一个单位 SD,SGRQ 的可比增加相对较弱,仅在 pi10 模型中显着(对于肺气肿百分比,高 1.45 个点,p=0.01)。在预测 BODE 的单独模型中,每项气道测量值增加 1 个单位 SD 即可预测更高的 BODE 评分(对于 WT,增加 1.07 倍,p<0.001;对于 WA%,增加 1.20 倍,p<0.001;对于 pi10,增加 1.16 倍,p<0.001)。在这些模型中,肺气肿对 BODE 的影响更为强烈(范围增加 1.24-1.26 倍,p<0.001)。肺气肿和气道疾病都与临床重要参数有关。气道疾病对SGRQ的相对影响更大;肺气肿对 BODE 的相对影响更大。
The value of quantitative computed tomography (QCT) to identify chronic obstructive pulmonary disease (COPD) phenotypes is increasingly appreciated. We hypothesized that QCT-defined emphysema and airway abnormalities relate to St. George's Respiratory Questionnaire (SGRQ) and BODE. 1,200 COPDGene subjects meeting GOLD criteria for COPD with QCT analysis were included. Total lung emphysema was measured using density mask technique with a -950 HU threshold. An automated program measured mean wall thickness (WT), wall area percent (WA%) and pi10 in six segmental bronchi. Separate multivariate analyses examined the relative influence of airway measures and emphysema on SGRQ and BODE. In separate models predicting SGRQ score, a one unit standard deviation (SD) increase in each airway measure predicted higher SGRQ scores (for WT, 1.90 points higher, p=0.002; for WA%, 1.52 points higher, p=0.02; for pi10, 2.83 points higher p<0.001). The comparable increase in SGRQ for a one unit SD increase in percent emphysema in these models was relatively weaker, significant only in the pi10 model (for percent emphysema, 1.45 points higher, p=0.01). In separate models predicting BODE, a one unit SD increase in each airway measure predicted higher BODE scores (for WT, 1.07 fold increase, p<0.001; for WA%, 1.20 fold increase, p<0.001; for pi10, 1.16 fold increase, p<0.001). In these models, emphysema more strongly influenced BODE (range 1.24-1.26 fold increase, p<0.001). Emphysema and airway disease both relate to clinically important parameters. The relative influence of airway disease is greater for SGRQ; the relative influence of emphysema is greater for BODE.
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