Automated computed tomography quantification of fibrosis predicts prognosis in combined pulmonary fibrosis and emphysema in a real-world setting: a single-centre, retrospective study.
Automated computed tomography quantification of fibrosis predicts prognosis in combined pulmonary fibrosis and emphysema in a real-world setting: a single-centre, retrospective study.
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DOI：
10.1186/s12931-020-01545-3
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发表时间：
2020-10-20
影响因子：
5.8
通讯作者：
Ryu JH
中科院分区：
文献类型：
--
作者：
Nemoto M;Nei Y;Bartholmai B;Yoshida K;Matsui H;Nakashita T;Motojima S;Aoshima M;Ryu JH
肺纤维化合并肺气肿（CPFE）是一种异质性的临床-放射学综合征，尚无统一的定义。关于实质纤维化程度与预后之间的关系的数据有限。在这项研究中，我们评估了自动定量计算机断层扫描（CT）技术评估的纤维化程度的预后意义，以及在现实环境中遇到的广谱纤维化间质性肺疾病（ILD）患者随时间推移的放射学和功能变化。我们对2007年至2015年在日本千叶龟田医疗中心遇到的228例连续CPFE患者进行了一项单中心回顾性研究。我们研究了自动CT纤维化定量和CPFE后续过程的预后价值。在228例CPFE患者中，89例在诊断时纤维化累及< 5%的肺，54例纤维化累及5至< 10%，85例纤维化累及≥ 10%。较低的纤维化体积与较低的死亡率和急性加重率相关（p < 0.001）。特别是，在纤维化< 5%的患者中，只有4.5%的患者在随访期间死亡，没有患者发生急性加重，而在纤维化≥ 10%的患者中，分别有57.6%和29.4%的患者发生死亡和急性加重。尽管≥ 10%纤维化组的总生存率最差，急性加重发生率最高，但肺功能检查下降、肺总体积每年变化和胸部CT显示纤维化进展的发生率在5至< 10%纤维化组中最高。CPFE进展的考克斯比例风险模型（定义为死亡、急性加重和用力肺活量或弥散能力下降的复合标准）显示，纤维化比例是独立于年龄、性别、吸烟包-年、Charlson合并症指数、肺癌、结缔组织病和特发性肺纤维化的风险因素。与纤维化ILD合并CPFE患者中更严重的纤维化相比，基线时较轻（< 5%）的纤维化与疾病稳定性和更好的预后相关。将需要进一步的研究，包括验证队列。试验注册追溯注册。
Combined pulmonary fibrosis and emphysema (CPFE) is a heterogeneous clinico-radiological syndrome without a consensus definition. There are limited data on the relation between the amount of parenchymal fibrosis and prognosis. In this study, we assessed the prognostic implications of the extent of fibrosis assessed by an automated quantitative computed tomography (CT) technique and the radiological and functional change over time in patients with a broad spectrum of fibrotic interstitial lung diseases (ILDs) encountered in a real-world setting. We conducted a single-centre, retrospective study of 228 consecutive patients with CPFE, encountered from 2007 to 2015 at Kameda Medical Center, Chiba, Japan. We investigated the prognostic value of automated CT fibrosis quantification and the subsequent course of CPFE. Among 228 patients with CPFE, 89 had fibrosis affecting < 5% of their lungs, 54 had 5 to < 10% fibrosis, and 85 had ≥ 10% fibrosis at the time of diagnosis. Lower volume of fibrosis correlated with lower rates of mortality and acute exacerbation (p < 0.001). In particular, among those with < 5% fibrosis, only 4.5% died and none experienced acute exacerbation during follow-up, whereas 57.6% and 29.4% of those with ≥ 10% fibrosis experienced death and acute exacerbation, respectively. Although, the ≥ 10% fibrosis group had the poorest overall survival as well as the highest incidence of acute exacerbation, the incidence of decline in pulmonary function tests, change per year in total lung volume, and progression of fibrosis on chest CT was highest in the 5 to < 10% fibrosis group. The Cox proportional hazard model for CPFE progression (defined by composite criteria of death, acute exacerbation, and decline in forced vital capacity or diffusing capacity) showed fibrosis proportion was a risk factor independent of age, sex, smoking pack-years, the Charlson Comorbidity Index, lung cancer, connective tissue disease, and idiopathic pulmonary fibrosis. Less severe (< 5%) fibrosis at baseline was associated with disease stability and better prognosis compared to more severe fibrosis in CPFE occurring with fibrotic ILDs. Further studies including a validation cohort will be needed. Trial Registration Retrospectively registered.
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对医疗统计信息的自由使用的易于使用的软件“ EZR”的调查。
影响因子：
4.8
作者：
Kanda Y
通讯作者：
Kanda Y
DOI：
10.1164/rccm.201612-2492oc
发表时间：
2017-11-01
影响因子：
24.7
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
Collard, Harold R.