Using Pulmonary Imaging to Move Chronic Obstructive Pulmonary Disease beyond FEV1
Using Pulmonary Imaging to Move Chronic Obstructive Pulmonary Disease beyond FEV1
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DOI：
10.1164/rccm.201402-0256pp
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发表时间：
2014-07-15
影响因子：
24.7
通讯作者：
Sin, Don D.
中科院分区：
文献类型：
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作者：
Coxson, Harvey O.;Leipsic, Jonathon;Sin, Don D.
FEV1用肺活量测定法测量，提供了一种简单、广泛、廉价的全球气流限制和肺功能测量方法。几十年来，FEV1一直是用于研究和开发新的慢性阻塞性肺疾病(COPD)疗法的主要中间终点。毫不奇怪，显著改善FEV1的治疗方法在COPD治疗中占据主导地位。然而，在COPD患者中，FEV1与病情恶化和死亡率等症状和结局的关系很弱，更重要的是，FEV1没有考虑COPD或其不同表型的异质性。胸部成像提供了一种方法来量化FEV1可能正常的戒烟者和肺功能非常轻微恶化的COPD患者的气道重塑、肺气肿破坏、区域通风异常(通风缺陷)和气体捕获。在个别患者和COPD队列研究中，使用X射线计算机断层扫描的胸部成像和磁共振成像(传统的H-1以及超极化惰性气体，如Xe-129、He-3和吸入的O-2和F-19)可以直接显示COPD的结构和功能后果，从而更清楚地了解COPD的机制、疾病进展和治疗反应。我们简要描述了一种肺成像方法，它提供了一种可视化和量化的方法，以高空间和时间分辨率，区域呼吸异常，气体捕获，肺气肿，和COPD的气道重塑。最后，我们讨论了最近的成像结果的含义以及它们对未来旨在改善COPD预后的生物标记物和治疗研究的影响。
FEV1, measured using spirometry, provides a straightforward, widely available, and inexpensive global measurement of airflow limitation and lung function. For decades, FEV1 has remained the main intermediate endpoint used in research studies and for the development of new chronic obstructive pulmonary disease (COPD) therapies. Not surprisingly, treatments that acutely improve FEV1 dominate as COPD therapies. However, in patients with COPD, the relationship of FEV1 with symptoms and outcomes such as exacerbations and mortality is weak, and, importantly, FEV1 does not take into account the heterogeneity of COPD or its different phenotypes. Thoracic imaging provides a way to quantify airway remodeling, emphysematous destruction, regional ventilation abnormalities (ventilation defects), and gas trapping in ex-smokers in whom FEV1 may be normal and in patients with COPD with very modest lung function deterioration. In individual patients and in COPD cohort studies, thoracic imaging using X-ray computed tomography, and magnetic resonance imaging (conventional H-1 as well as hyperpolarized noble gases such as Xe-129, He-3, and inhaled O-2 and F-19) can be used to directly visualize the structural and functional consequences of COPD and thus provide a clearer picture of COPD mechanisms, disease progression, and response to therapy. We briefly describe pulmonary imaging methods that provide a way to visualize and quantify, with high spatial and temporal resolution, regional ventilation abnormalities, gas trapping, emphysema, and airway remodeling in COPD. Finally, we discuss the implications of recent imaging findings and their impact on future biomarker and therapy research aimed at improving COPD outcomes.