Spirometrically gated high-resolution CT findings in COPD - Lung attenuation vs lung function and dyspnea severity
Spirometrically gated high-resolution CT findings in COPD - Lung attenuation vs lung function and dyspnea severity
复制标题
DOI：
10.1378/chest.129.3.558
复制
发表时间：
2006-03-01
期刊：
影响因子：
9.6
通讯作者：
Pistolesi, M
中科院分区：
文献类型：
--
作者：
Camiciottoli, G;Bartolucci, M;Pistolesi, M
研究目的：本研究的目的是探讨COPD患者在吸气和呼气肺容量控制下获得的高分辨率CT(HRCT)肺衰减测量与肺功能障碍和呼吸困难严重程度的关系。患者和设计：51例COPD患者，我们用线性回归、单变量和多变量Logistic回归的气流限制(FEV1/肺活量[VC])、过度充气(预计残气量的百分比[RV%])、实质损失(预计的一氧化碳弥散量的百分比[DLCO%])和医学研究委员会(MRC)的呼吸困难分级与衰减的相对面积和Lt进行比较；-950HU和-910HU，肺活量为VC的10%，肺平均密度为VC的10%，肺平均密度为VC的10%，肺密度为VC的90%。结果：所有HRCT衰减测量均与功能异常和呼吸困难程度显著相关。在多变量Logistic模型中，当I表示二分结果变量的变化更严重时，MeanCT(EXP)独立预测FEV1/NC(优势比[OR]，0.24；95%可信区间[CI]，0.11至0.56)、RV%(OR，0.57；95%CI，0.42至0.77)和MRC呼吸困难评分(OR，0.63；95%CI，0.48至0.82)，而RAI(950)独立预测DLCO%(OR，1.90；95%可信区间为1.37~2.65。结论：肺活量门控测量反映了COPD患者不同程度的肺功能改变和呼吸困难。吸气测量评估肺气肿组织丢失的程度，呼气测量可反映气流受限和伴随呼吸困难的肺过度充气。COPD患者的肺功能障碍不能通过单一的肺衰减测量来评估。
Study objectives: The aim of this study was to investigate the relationship between high-resolution CT (HRCT) lung attenuation measurements, acquired under spirometric control of inspiratory and expiratory lung volume, and pulmonary dysfunction as well as dyspnea severity in patients with COPD.Patients and design: In 51 patients with COPD, we compared by linear regression, univariate and multivariate logistic regression airflow limitation (FEV1/vital capacity [VC]), hyperinflation (percentage of predicted residual volume [RV%]), parenchymal loss (percentage of predicted diffusing capacity of the lung for carbon monoxide [DLCO%]) and Medical Research Council (MRC) dyspnea scale with relative area with attenuation values < -950 HU at 90% of VC [RAI(950)] and < -910 HU at 10% of VC, respectively, and with mean lung attenuation measured at the same levels of VC (mean CT lung density at 10% of VC, and mean CT lung density at 90% of VC [MeanCT(EXP)]).Results: All HRCT attenuation measurements were significantly related with functional abnormalities and dyspnea severity. In multivariate logistic models, with I indicating worse changes in dichotomous outcome variables, MeanCT(EXP) independently predicted FEV1/NC (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11 to 0.56), RV% (OR, 0.57; 95% CI, 0.42 to 0.77), and MRC dyspnea scale (OR, 0.63; 95% CI, 0.48 to 0.82), while RAI(950) independently predicted DLCO% (OR, 1.90; 95% CI, 1.37 to 2.65).Conclusions: Spirometrically gated measurements of HRCT lung attenuation reflect differently functional changes and dyspnea perception in COPD. Inspiratory measurements assess the extent of emphysematous tissue loss, and expiratory measurements may reflect airflow limitation and lung hyperinflation with attendant dyspnea perception. Pulmonary dysfunction in COPD cannot be assessed by a single modality of lung attenuation measurement.