Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study.
Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study.
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哮喘和慢性阻塞性肺部疾病患者的气道重塑，空气捕获和肺气肿的定量计算机断层扫描参数之间的关系：一项单中心研究。
DOI：
10.1016/j.jaci.2016.02.001
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Brightling CE
中科院分区：
文献类型：
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作者：
Hartley RA;Barker BL;Newby C;Pakkal M;Baldi S;Kajekar R;Kay R;Laurencin M;Marshall RP;Sousa AR;Parmar H;Siddiqui S;Gupta S;Brightling CE
基于胸部定量计算机断层扫描（QCT）参数比较哮喘和慢性阻塞性肺疾病（COPD）的研究很少。我们试图比较哮喘患者和COPD患者的气道重塑、空气潴留和肺气肿的QCT参数，并探讨它们与气流受限的关系。从一个中心招募的哮喘患者（n = 171）、COPD患者（n = 81）和健康受试者（n = 49）接受QCT和临床表征。哮喘患者（62.5% [SD，2.2]）和COPD患者（62.7%[SD，2.3]）的近端气道壁面积百分比（%WA）显著高于健康对照组（60.3% [SD，2.2]，P <0.001）。根据平均肺密度呼气/吸气比测量的空气潴留在COPD患者（平均值，0.922 [SD，0.037]）和哮喘患者（平均值，0.852 [SD，0.061]）中显著高于健康受试者（平均值，0.816 [SD，0.066]，P <0.001）。根据使用Hounsfield单位测量的肺密度评估肺气肿，低于15%的体素（Perc 15）仅是COPD的一个特征（COPD患者：平均值为−964 [SD，19.62]，哮喘患者：平均值为−937 [SD，22.7]，健康受试者：平均值为−937 [SD，17.1]，P <0.001）。多元回归分析显示，哮喘患者肺功能损害的最强预测因子是%WA，而在COPD和哮喘亚组中，使用支气管扩张剂后FEV 1百分比预测值小于80%，则是空气潴留。对哮喘患者和COPD患者的QCT参数进行因子分析，确定了3个组分，%WA、空气滞留和Perc 15值是最高负荷因子。聚类分析确定了3个具有轻度、中度或重度肺功能损害的聚类，相应的肺密度（Perc 15值）降低和空气潴留增加。在哮喘患者和COPD患者中，肺功能损害与空气潴留密切相关，哮喘患者的近端气道狭窄也有贡献。
There is a paucity of studies comparing asthma and chronic obstructive pulmonary disease (COPD) based on thoracic quantitative computed tomographic (QCT) parameters. We sought to compare QCT parameters of airway remodeling, air trapping, and emphysema between asthmatic patients and patients with COPD and explore their relationship with airflow limitation. Asthmatic patients (n = 171), patients with COPD (n = 81), and healthy subjects (n = 49) recruited from a single center underwent QCT and clinical characterization. Proximal airway percentage wall area (%WA) was significantly increased in asthmatic patients (62.5% [SD, 2.2]) and patients with COPD (62.7% [SD, 2.3]) compared with that in healthy control subjects (60.3% [SD, 2.2], P < .001). Air trapping measured based on mean lung density expiratory/inspiratory ratio was significantly increased in patients with COPD (mean, 0.922 [SD, 0.037]) and asthmatic patients (mean, 0.852 [SD, 0.061]) compared with that in healthy subjects (mean, 0.816 [SD, 0.066], P < .001). Emphysema assessed based on lung density measured by using Hounsfield units below which 15% of the voxels lie (Perc15) was a feature of COPD only (patients with COPD: mean, −964 [SD, 19.62] vs asthmatic patients: mean, −937 [SD, 22.7] and healthy subjects: mean, −937 [SD, 17.1], P < .001). Multiple regression analyses showed that the strongest predictor of lung function impairment in asthmatic patients was %WA, whereas in the COPD and asthma subgrouped with postbronchodilator FEV1 percent predicted value of less than 80%, it was air trapping. Factor analysis of QCT parameters in asthmatic patients and patients with COPD combined determined 3 components, with %WA, air trapping, and Perc15 values being the highest loading factors. Cluster analysis identified 3 clusters with mild, moderate, or severe lung function impairment with corresponding decreased lung density (Perc15 values) and increased air trapping. In asthmatic patients and patients with COPD, lung function impairment is strongly associated with air trapping, with a contribution from proximal airway narrowing in asthmatic patients.