定量CT在鉴别支气管热成形治疗反应中的应用
2024/01/26
摘要
背景：支气管热成形术（BT）是一种治疗控制不良、重症哮喘的方法。然而，BT治疗反应的预测因素还不明确。
研究问题：是否存在预测BT反应的基线放射学和临床特征？
研究设计和方法：我们在8个学术医疗中心对接受BT治疗的重症哮喘参与者进行了纵向前瞻性队列研究。参与者接受了3次单独的BT治疗，并在BT后1年内每隔3个月进行一次监测。与之前的研究类似，对BT的阳性反应被定义为哮喘控制测试（ACT）的改善≥3或哮喘生活质量问卷（AQLQ）的改善≤0.5。回归分析用于评估治疗前临床和定量CT（qCT）测量与随后BT反应之间的关系。
结果：从2006年到2017年，88名参与者接受了BT治疗，其中70人（79.5%）通过ACT或AQLQ标准确定为应答者。应答者在前一年入住哮喘相关ICU的可能性较低（3%vs 25%，P=0.01）。在基线qCT中，BT应答者的空气截留率较低（比值比[OR]=0.90，95%置信区间[CI] 0.82～0.99，P=0.03），雅可比行列式较大（OR=1.49，95%CI 1.05～2.11），雅可比行列式的标准偏差（SD）越大（OR=1.84，95%CI 1.04～3.26），各向异性变形指数越大（OR=3.06，95%CI 1.05～8.86）。
解释：据我们所知，这是评估基线qCT和与BT反应相关的临床特征的最大研究。我们的研究结果表明，保持正常的肺扩张（表现为较少的空气滞留、较大的各向同性扩张幅度和较大的qCT肺内空间变化）是未来BT反应的预测因素。
Use of Quantitative CT to Identify Bronchial Thermoplasty Responders
Maanasi Samant, James G Krings, Daphne Lew, Charles W Goss, Tammy Koch, Mary Clare McGregor, Jonathan Boomer, Chase S Hall, Ken B Schechtman, Ajay Sheshadri, Samuel Peterson, Serpil Erzurum, Zachary DePew, Lee E Morrow, D Kyle Hogarth, Richard Tejedor, Jennifer Trevor, Michael E Wechsler, Afshin Sam, Xiaosong Shi, Jiwoong Choi, Mario Castro
Abstract
Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are poorly defined.
Research question: Are there baseline radiographic and clinical characteristics that predict response to BT?
Study design and methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across 8 academic medical centers. Participants received 3 separate BT treatments and were monitored at 3-month intervals for 1 year following BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test (ACT) of ≥3 or Asthma Quality of Life Questionnaire (AQLQ) of ≥0.5. Regression analyses were utilized to evaluate the association between pre-treatment clinical and quantitative CT (qCT) measures with subsequent BT response.
Results: From 2006 to 2017, 88 participants received BT with 70 (79.5%) identified as responders by ACT or AQLQ criteria. Responders were less likely to have an asthma-related ICU admissions in the prior year (3% vs 25%, P=0.01). On baseline qCT, BT responders had less air trapping percentage (odds ratio [OR] = 0.90, 95% confidence interval [CI] 0.82 to 0.99, P=0.03), a greater Jacobian determinant (OR = 1.49, 95% CI 1.05 to 2.11), greater standard deviation (SD) of the Jacobian determinant (OR = 1.84, 95% CI 1.04 to 3.26), and greater anisotropic deformation index (OR = 3.06, 95% CI 1.06 to 8.86]).
Interpretation: To our knowledge, this is the largest study to evaluate baseline qCT and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on qCT were predictors of future BT response.
背景：支气管热成形术（BT）是一种治疗控制不良、重症哮喘的方法。然而，BT治疗反应的预测因素还不明确。
研究问题：是否存在预测BT反应的基线放射学和临床特征？
研究设计和方法：我们在8个学术医疗中心对接受BT治疗的重症哮喘参与者进行了纵向前瞻性队列研究。参与者接受了3次单独的BT治疗，并在BT后1年内每隔3个月进行一次监测。与之前的研究类似，对BT的阳性反应被定义为哮喘控制测试（ACT）的改善≥3或哮喘生活质量问卷（AQLQ）的改善≤0.5。回归分析用于评估治疗前临床和定量CT（qCT）测量与随后BT反应之间的关系。
结果：从2006年到2017年，88名参与者接受了BT治疗，其中70人（79.5%）通过ACT或AQLQ标准确定为应答者。应答者在前一年入住哮喘相关ICU的可能性较低（3%vs 25%，P=0.01）。在基线qCT中，BT应答者的空气截留率较低（比值比[OR]=0.90，95%置信区间[CI] 0.82～0.99，P=0.03），雅可比行列式较大（OR=1.49，95%CI 1.05～2.11），雅可比行列式的标准偏差（SD）越大（OR=1.84，95%CI 1.04～3.26），各向异性变形指数越大（OR=3.06，95%CI 1.05～8.86）。
解释：据我们所知，这是评估基线qCT和与BT反应相关的临床特征的最大研究。我们的研究结果表明，保持正常的肺扩张（表现为较少的空气滞留、较大的各向同性扩张幅度和较大的qCT肺内空间变化）是未来BT反应的预测因素。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Chest. 2023 Dec 18:S0012-3692(23)05871-3. doi: 10.1016/j.chest.2023.12.015.)
(Chest. 2023 Dec 18:S0012-3692(23)05871-3. doi: 10.1016/j.chest.2023.12.015.)
Use of Quantitative CT to Identify Bronchial Thermoplasty Responders
Maanasi Samant, James G Krings, Daphne Lew, Charles W Goss, Tammy Koch, Mary Clare McGregor, Jonathan Boomer, Chase S Hall, Ken B Schechtman, Ajay Sheshadri, Samuel Peterson, Serpil Erzurum, Zachary DePew, Lee E Morrow, D Kyle Hogarth, Richard Tejedor, Jennifer Trevor, Michael E Wechsler, Afshin Sam, Xiaosong Shi, Jiwoong Choi, Mario Castro
Abstract
Background: Bronchial thermoplasty (BT) is a treatment for patients with poorly controlled, severe asthma. However, predictors of treatment response to BT are poorly defined.
Research question: Are there baseline radiographic and clinical characteristics that predict response to BT?
Study design and methods: We conducted a longitudinal prospective cohort study of participants with severe asthma receiving BT across 8 academic medical centers. Participants received 3 separate BT treatments and were monitored at 3-month intervals for 1 year following BT. Similar to prior studies, a positive response to BT was defined as either improvement in Asthma Control Test (ACT) of ≥3 or Asthma Quality of Life Questionnaire (AQLQ) of ≥0.5. Regression analyses were utilized to evaluate the association between pre-treatment clinical and quantitative CT (qCT) measures with subsequent BT response.
Results: From 2006 to 2017, 88 participants received BT with 70 (79.5%) identified as responders by ACT or AQLQ criteria. Responders were less likely to have an asthma-related ICU admissions in the prior year (3% vs 25%, P=0.01). On baseline qCT, BT responders had less air trapping percentage (odds ratio [OR] = 0.90, 95% confidence interval [CI] 0.82 to 0.99, P=0.03), a greater Jacobian determinant (OR = 1.49, 95% CI 1.05 to 2.11), greater standard deviation (SD) of the Jacobian determinant (OR = 1.84, 95% CI 1.04 to 3.26), and greater anisotropic deformation index (OR = 3.06, 95% CI 1.06 to 8.86]).
Interpretation: To our knowledge, this is the largest study to evaluate baseline qCT and clinical characteristics associated with BT response. Our results show that preservation of normal lung expansion, indicated by less air trapping, a greater magnitude of isotropic expansion, and greater within-lung spatial variation on qCT were predictors of future BT response.
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新生儿气道细菌定植与18岁前哮喘和过敏风险的关系
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性别对重症哮喘的影响：英国初级和专科护理的横断面回顾性分析
