定量CT检测气流闭陷的哮喘表型的危险因素—一项多因素分析
2009/05/18
在生理学上，对重症哮喘患者气流闭陷的检测手段已有所增加，然而应用CT检测气流闭陷的方法还未实行。对此，Ashley Busacker等人基于以下两个假设条件进行了一项研究，即（1）由多控测器CT（MDCT）定量检测气流闭陷程度可预示极重度哮喘；（2）通过多因素分析可辨别病史、临床表现、过敏史、炎症反应等多种危险因素。
该项有关重症哮喘的研究中所有病例均需经过MDCT扫描并进行功能残气量检测。将超过（≥） 9.66%的肺组织CT值<850HU者定义为气流闭陷。该研究将病例按是否存在气流闭陷分类，然后收集两组病例的临床和人口统计学资料，进行单因素和多因素统计学分析。
结果发现，存在气流闭陷的患者，既往更可能有因哮喘入院或入ICU（伴或不伴有机械通气）治疗的历史。
该研究还发现了与气流闭陷相关的一些独立危险因素，包括有哮喘持续时间(似然比[OR] 1.42; 95%可信区间[CI], 1.08：1.87)、肺炎病史(OR，8.55; 95% CI, 2.07 to 35.26)、气道中性粒细胞增高(OR, 8.67; 95% CI, 2.05 to 36.57)、气道阻塞(FEV1/FVC) [OR, 1.61; 95% CI, 1.21 to 2.14]和遗传性过敏症(OR, 11.54; 95% CI, 1.97 to 67.70)。
Ashley的研究提出，在哮喘患者中应用MDCT法检测出的气道闭陷，可预示一些高危的重症患者。同时该研究也检测出了包括肺炎病史、中性粒细胞相关性炎症以及遗传性过敏症在内的一些与气道闭陷相关的独立危险因素。
（于娜 中国医科大学附属第一医院呼吸科 110001 摘译）
（Chest January 2009 135:48-56; doi:10.1378/chest.08-0049）
（Chest January 2009 135:48-56; doi:10.1378/chest.08-0049）
A Multivariate Analysis of Risk Factors for the Air-Trapping Asthmatic Phenotype as Measured by Quantitative CT Analysis
1.Ashley Busacker, PhD*,
2.John D. Newell, Jr, MD, FCCP,
3.Thomas Keefe, PhD,
4.Eric A. Hoffman, PhD,
5.Janice Cook Granroth, BS,
6.Mario Castro, MD, FCCP,
7.Sean Fain, PhD and
8.Sally Wenzel, MD, FCCP
Abstract
Background:Patients with severe asthma have increased physiologically measured air trapping; however, a study using CT measures of air trapping has not been performed. This study was designed to address two hypotheses: (1) air trapping measured by multidetector CT (MDCT) quantitative methodology would be a predictor of a more severe asthma phenotype; and (2) historical, clinical, allergic, or inflammatory risk factors could be identified via multivariate analysis.
Methods:MDCT scanning of a subset of Severe Asthma Research Program subjects was performed at functional residual capacity. Air trapping was defined as ≥ 9.66% of the lung tissue < − 850 Hounsfield units (HU). Subjects classified as having air trapping were then compared to subjects without air trapping on clinical and demographic factors using both univariate and multivariate statistical analyses.
Results:Subjects with air trapping were significantly more likely to have a history of asthma-related hospitalizations, ICU visits, and/or mechanical ventilation. Duration of asthma (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.08 to 1.87), history of pneumonia (OR, 8.55; 95% CI, 2.07 to 35.26), high levels of airway neutrophils (OR, 8.67; 95% CI, 2.05 to 36.57), airflow obstruction (FEV1/FVC) [OR, 1.61; 95% CI, 1.21 to 2.14], and atopy (OR, 11.54; 95% CI, 1.97 to 67.70) were identified as independent risk factors associated with the air-trapping phenotype.
Conclusions:Quantitative CT-determined air trapping in asthmatic subjects identifies a group of individuals at high risk for severe disease. Several independent risk factors for the presence of this phenotype were identified: perhaps most interestingly, history of pneumonia, neutrophilic inflammation, and atopy.
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