可以应用CT和一氧化碳弥散系数诊断具有哮喘特点的COPD患者吗？
2017/09/29
背景：验尸和CT检查证实肺气肿是即使在“蓝肿/慢性支气管炎”型COPD患者中也存在的特点。我们的研究目的是验证非肺气肿的COPD患者与大部分COPD 患者不同，更类似于哮喘患者。
方法：我们分析了54名COPD患者。通过CT的戈达德视觉评分及CO弥散系数界定肺气肿。用支气管粘膜活检提示基底膜增厚(≥7 μm)作为不可逆性哮喘的气道重塑标志。使用布地奈德福莫特罗治疗1年后复查肺功能。
结果：CT扫描提示54名患者中有24名(44%)为非肺气肿表型的患者，一氧化碳弥散系数提示54名患者中有23人为非肺气肿表型。54名患者中两者对是否存在肺气肿的界定在53名患者中存在一致性。非气肿性患者较年轻，FEV 1较高 (非肺气肿中位数61%，肺气肿表型中位数49.7%)，鼻甲肥大和高血清IgE的比例更高。气肿型COPD患者有较低的BMI指数和更高的呼吸困难评分。在非气肿的14名病人中，有11名存在基底膜增厚，而气肿型COPD10名患者中0人合并基底膜增厚。3名非肺气肿且无基底膜增厚的患者在吸入ICS/LABA后FEV 1达正常标准。所有的非气肿患者在吸入ICS/LABA后FEV 1都得到提高 (中位数215ml)。气肿型COPD患者FEV1下降的中位数是65ml。
结论：COPD非肺气肿型患者在临床表现、组织学和对ICS的治疗反应上具有哮喘的特点。CT和一氧化碳弥散系数可以预测ICS/LABA对改善肺活量的效果。
(Respirology (2017) 22, 322–328 )
Can computed tomography and carbon monoxide transfer coefficient diagnose an asthma-like phenotype in COPD?
FEISAL A. AL-KASSIMI,ESAMH. ALHAMAD, MOHAMMEDS. AL-HAJJAJ, EMAD RADDAOUI, ABDULAZIZH. ALZEER, AHMADA. ALBOUKAI, ALIM. SOMILY, JOSEPH G.CAL, ABDALLAF. IBRAHIMAND SHAFFIA. SHAIK
Abstract
BACKGROUND: Post-mortem and computed tomography (CT) studies indicated that emphysema is a feature of COPD even in the ‘blue bloater/chronic bronchitis’ type. We aim to test the hypothesis that the non-emphysematous patients are distinct from the mainbody of COPD and are more akin to asthmatic patients.
METHODS:We studied 54 patients with COPD. Emphysema was measured by Goddard’s visual scoring of CT scan and the carbon monoxide transfer coefficient (KCO). Bronchial biopsy was offered for thickness of basement membrane (BM) (≥7 μm) as a marker of remodelling in irreversible asthma. Spirometry was repeated after therapy with Budesonide/Formoterol for 1 year.
Results: The non-emphysematous phenotype were 24 of 54 patients (44%) by CT scan and 23 of 54 patients (43%) by KCO, showing agreement in 53 out of 54 patients. The non-emphysematous patients were younger, had higher forced expiratory volume in 1 s (FEV 1 ) (median 61% vs 49.7%), greater prevalence of hypertrophy of nasal turbinates and higher serum IgE.The emphysematous phenotype had lower BMI and greater dyspnoea score. The BM was thickened in 11 of 14 and 0 of 10 patients in the non-emphysematous and emphysematous groups, respectively. Three patients without emphysema and a normal BM normalized their FEV 1 upon receiving inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA). All the non-emphysematous improved their FEV 1 after ICS/LABA (median = 215mL). The median decline in the emphysematous was −65 mL.
CONCLUSIONS:The non-emphysematous phenotype of COPD displays important features of asthma: clinical picture, histology and response to ICS. CT and KCO can predict spirometric response to ICS/LABA.
