Predictive Value of Quantitative CT Detection of Pi10 in Treatment Response of COPD Patients
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摘要: 目的：通过定量CT扫描分析明确慢性阻塞性肺疾病（COPD）患者随访1年内治疗反应的预测因素。方法：研究对象为113例COPD患者，患者每天接受两次吸入长效β-激动剂和皮质类固醇联合治疗，持续3个月，随后接受药物治疗，通过基线CT扫描获得肺气肿指数（EI）、空气滞留指数（ATI）和假设气道周径为10 mm时的管壁面积平方根（Pi10）。临床上有意义治疗反应定义为在1年随访中，1 s用力呼气量（FEV1）增加≥0.225 L。采用多变量逻辑回归分析来FEV1升高的预测因素。结果：23例患者（20.4%）出现治疗反应，反应患者的平均FEV1增加为（0.35±0.11） L。在单变量分析中，治疗反应患者和无反应患者之间ATI、肺气肿区ATI和Pi10参数之间有显著差异（所有P<0.05）；多变量分析显示，Pi10是预测FEV1升高的唯一独立变量（OR：1.789，95% CI：1.221~2.618，P=0.003）。结论：基线定量CT测量Pi10可以预测COPD患者1年随访期的治疗反应。Abstract: Objective:To determine the predictive factors for treatment responsiveness in patients with chronic obstructive pulmonary disease(COPD) at 1-year follow-up by performing quantitative analyses of CT scans. Methods:The subjects were 113 patients with COPD. Patients received a combination of inhaled long-acting beta-agonists and corticosteroids twice daily for 3 months and subsequently received medications according to the practicing clinician's decision. The emphysema index(EI), airtrapping indices(ATI), and hypothetical airway wtih internal perimeter of 10 mm(Pi10) were obtained with baseline CT scans. Clinically meaningful treatment response was defined as an absolute increase of ≥ 0.225 L in the forced expiratory volume in 1 second(FEV1) at the one-year follow-up. Multivariate logistic regression analysis was performed to investigate the predictors of an increase in FEV1. Results:Treatment response was noted in 23 patients(20.4%). The mean FEV1 increase in responders was(0.35 ±0.11) L. On univariate analysis, the air-trapping index(ATI), ATI of the emphysematous area, and Pi10 parameter differed significantly between treatment responders and non-responders(all P<0.05). Multivariate analysis revealed that the Pi10 was the only independent variable predictive of an FEV1 increase(OR:1.78; 95% CI:1.221~2.618, P=0.003). Conclusion:Pi10, an airway parameter measured by baseline quantitative chest CT, can be used to predict an increase in FEV1 of ≥ 0.225 L in patients with COPD during a 1 year follow-up period.
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