Qualitative Analysis of High-Resolution CT Scans in Severe Asthma
Qualitative Analysis of High-Resolution CT Scans in Severe Asthma
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DOI：
10.1378/chest.09-0174
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发表时间：
2009-12-01
期刊：
影响因子：
9.6
通讯作者：
Brightling, Christopher E.
中科院分区：
文献类型：
--
作者：
Gupta, Sumit;Siddiqui, Salman;Brightling, Christopher E.
背景：高分辨率CT(HRCT)扫描是重症哮喘治疗的一部分，但其应用因中心而异。我们试图描述一个大的重症哮喘队列的HRCT扫描异常，并确定临床特征对指导这一组患者使用HRCT扫描的有效性。方法：对2000年2月至2006年11月在我们困难哮喘诊所(DAC)就诊的463例患者进行广泛的重新表征，其中185例接受了HRCT扫描。对HRCT扫描进行定性分析，并评估观察者间的变异性。结果：80%的受试者存在HRCT扫描异常，且常与支气管壁扩张(62%)、支气管壁增厚(40%)和肺气肿(8%)并存。观察员之间对BE(kappa=0.76)和BWT(kappa=0.63)的协议是实质性的。接受HRCT扫描的DAC患者与未接受HRCT扫描的患者相比，年龄更大，病程更长，肺功能更差，接受更高剂量的皮质类固醇治疗，中性粒细胞气道炎症增加。临床检测BE的敏感性和特异性分别为74%和45%。FEV1/FVC比值是BE和BWT的重要预测指标，但对于无呼吸道结构改变的受试者(FEV1/FVC比值=75%；敏感度为67%；特异度为65%)的判别价值较差。结论：重度哮喘患者HRCT扫描异常常见。非放射学评估不能可靠地预测重要的支气管壁改变；因此，所有重症哮喘患者可能都需要CT扫描。(《胸部》2009；136：1521-1528)
Background: High-resolution CT (HRCT) scanning is part of the management of severe asthma, but its application varies between centers. We sought to describe the HRCT scan abnormalities of a large severe asthma cohort and to determine the utility of clinical features to direct the use of HRCT scanning in this group of patients.Methods: Subjects attending our Difficult Asthma Clinic (DAC) between February 2000 and November 2006 (n = 463) were extensively re-characterized and 185 underwent HRCT scan. The HRCT scans were analyzed qualitatively and the interobserver variability was assessed. Using logistic regression we defined clinical parameters that were associated with bronchiectasis (BE) and bronchial wall thickening (BWT) alone or in combination.Results: HRCT scan abnormalities were present in 80% of subjects and often coexisted with BWT (62%), BE (40%), and emphysema (8%). The interobserver agreement for BE (kappa = 0.76) and BWT (kappa = 0.63) was substantial. DAC patients who underwent HRCT scanning compared with those who did not were older, had longer disease duration, had poorer lung function, were receiving higher doses of corticosteroids, and had increased neutrophilic airway inflammation. The sensitivity and specificity, of detecting BE clinically were 74% and 45%, respectively. FEV1/FVC ratio emerged as an important predictor for both BE and BWT but had poor discriminatory utility for subjects who did not have airway structural changes (FEV1/FVC ratio, >= 75%; sensitivity, 67%; specificity, 65%).Conclusion: HRCT scan abnormalities are common in patients with severe asthma. Nonradiologic assessments fail to reliably predict important bronchial wall changes; therefore, CT scan acquisition may be required in all patients with severe asthma. (CHEST 2009; 136:1521-1528)