肺气肿对特发性肺纤维化肺功能的生理和预后特征的影响。

Effects of emphysema on physiological and prognostic characteristics of lung function in idiopathic pulmonary fibrosis.

机构信息

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

出版信息

Respirology. 2019 Jan;24(1):55-62. doi: 10.1111/resp.13387. Epub 2018 Aug 23.

DOI:10.1111/resp.13387

PMID:30136753

Abstract

BACKGROUND AND OBJECTIVE

Combined pulmonary fibrosis and emphysema (CPFE) is characterized by preserved lung volume and slower lung function decline. However, it is unclear at what extent emphysema begins to impact respiratory physiology and prognostic characteristics in idiopathic pulmonary fibrosis (IPF). We estimated the extent of emphysema that could be used to define CPFE in IPF.

METHODS

The extent of emphysema was observed on high-resolution computed tomography scans and measured by a texture-based automated quantification system in 209 IPF patients. We analysed the impact of differences in the extent of emphysema on the annual decline rate and prognostic significance of lung function parameters.

RESULTS

The extent of emphysema was ≥5% in 53 patients (25%), ≥10% in 23 patients (11%) and ≥15% in 12 patients (6%). Patients with emphysema to an extent of ≥5% were more frequently men and ever-smokers; they had more preserved lung volume and lower forced vital capacity (FVC) decline rates than those with no or trivial emphysema. The FVC decline rate was a significant predictor of mortality in patients with no or trivial emphysema (hazard ratio (HR): 0.933, P < 0.001) and in patients with an extent of emphysema ≥5% (HR: 0.906, P < 0.001). However, diffusing capacity of the lung for carbon monoxide (DL ) was the most significant prognostic factor in those patients with an extent of emphysema ≥10% (HR: 0.972, P = 0.040) and ≥15% (HR: 0.942, P = 0.023). A 10% cut-off value for the extent of emphysema created the most significant difference in the annual FVC decline rate in IPF patients.

CONCLUSION

In IPF, emphysema to an extent of ≥10% affects both the annual decline rate and the prognostic significance of FVC. This extent could be used to define CPFE.

摘要

背景和目的

肺纤维化合并肺气肿（CPFE）的特点是肺容积保持不变，肺功能下降速度较慢。然而，在特发性肺纤维化（IPF）中，肺气肿在多大程度上开始影响呼吸生理和预后特征尚不清楚。我们估计了肺气肿的程度，以便在 IPF 中定义 CPFE。

方法

在 209 例 IPF 患者的高分辨率计算机断层扫描（HRCT）上观察肺气肿的程度，并通过基于纹理的自动定量系统进行测量。我们分析了肺气肿程度的差异对肺功能参数的年下降率和预后意义的影响。

结果

53 例（25%）患者的肺气肿程度≥5%，23 例（11%）患者的肺气肿程度≥10%，12 例（6%）患者的肺气肿程度≥15%。肺气肿程度≥5%的患者更常见于男性和曾吸烟者；与无或轻微肺气肿的患者相比，他们的肺容积保留更多，用力肺活量（FVC）下降率更低。在无或轻微肺气肿的患者（危险比（HR）：0.933，P<0.001）和肺气肿程度≥5%的患者（HR：0.906，P<0.001）中，FVC 下降率是死亡率的显著预测因素。然而，在肺气肿程度≥10%的患者（HR：0.972，P=0.040）和≥15%的患者（HR：0.942，P=0.023）中，一氧化碳弥散量（DLCO）是最显著的预后因素。肺气肿程度的 10%截断值在 IPF 患者的 FVC 年下降率中产生了最显著的差异。