背景:Birt-Hogg-Dubé(BHD)综合征是一种罕见的常染色体显性遗传病,其特征是纤维叶瘤,肾肿瘤,肺囊肿,和复发性气胸.肺囊肿是复发性气胸的原因,是影响患者生活质量的重要因素之一。尚不清楚BHD综合征患者的肺囊肿是否随时间进展或影响肺功能。这项研究通过使用胸部计算机断层扫描(CT)调查了长期随访(FU)期间肺囊肿是否进展以及FU期间肺功能是否下降。我们还评估了FU期间BHD患者气胸的危险因素。
方法:我们的回顾性队列包括43例BHD患者(25例女性;平均年龄,54.2±11.7年)。我们使用初始和连续胸部CT通过视觉评估和定量体积分析来评估囊肿是否进展。视觉评估包括尺寸,location,number,形状,分布,可见的墙壁的存在,腓骨或胸膜下囊肿,和空气袖口标志。在从17名患者的1毫米切片获得的CT数据中,通过使用内部软件测量低衰减区的体积进行定量评估.我们在系列肺功能测试(PFT)中评估了肺功能是否随时间下降。采用多元回归分析气胸的危险因素。
结果:关于视觉评估,右肺最大的囊肿显示出明显的间隔大小增加(1.0毫米/年,p=0.0015;95%置信区间[CI],0.42-1.64)在初始CT和最终CT之间,左肺最大的囊肿也显示出明显的间隔大小增加(0.8毫米/年,p<0.001,95%CI;-0.49-1.09)。在定量评估上,囊肿有逐渐增大的趋势。在有可用PFT数据的33名患者中,FEV1pred%,FEV1/FVC,和VCpred%显示出统计学上显著的随时间下降(每个p<0.0001)。气胸家族史是气胸发展的危险因素。
结论:在BHD患者的纵向随访胸部CT中,肺囊肿的大小随时间进展,纵向随访PFT,肺功能略有恶化。
BACKGROUND: Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal dominant disorder characterized by fibrofolliculomas, renal tumors, pulmonary cysts, and recurrent pneumothorax. Pulmonary cysts are the cause of recurrent pneumothorax, which is one of the most important factors influencing patient quality of life. It is unknown whether pulmonary cysts progress with time or influence pulmonary function in patients with BHD syndrome. This
study investigated whether pulmonary cysts progress during long-term follow-up (FU) by using thoracic computed tomography (CT) and whether pulmonary function declines during FU. We also evaluated risk factors for pneumothorax in patients with BHD during FU.
METHODS: Our retrospective cohort included 43 patients with BHD (25 women; mean age, 54.2 ± 11.7 years). We evaluated whether cysts progress by visual assessment and quantitative volume analysis using initial and serial thoracic CT. The visual assessment included the size, location, number, shape, distribution, presence of a visible wall, fissural or subpleural cysts, and air-cuff signs. In CT data obtained from a 1-mm section from 17 patients, the quantitative assessment was performed by measuring the volume of the low attenuation area using in-house software. We evaluated whether the pulmonary function declined with time on serial pulmonary function tests (PFT). Risk factors for pneumothorax were analyzed using multiple regression analysis.
RESULTS: On visual assessment, the largest cyst in the right lung showed a significant interval increase in size (1.0 mm/year, p = 0.0015; 95% confidence interval [CI], 0.42-1.64) between the initial and final CT, and the largest cyst in the left lung also showed significant interval increase in size (0.8 mm/year, p < 0.001, 95% CI; -0.49-1.09). On quantitative assessment, cysts had a tendency to gradually increase in size. In 33 patients with available PFT data, FEV1pred%, FEV1/FVC, and VCpred% showed a statistically significant decrease with time (p < 0.0001 for each). A family history of pneumothorax was a risk factor for the development of pneumothorax.
CONCLUSIONS: The size of pulmonary cysts progressed over time in longitudinal follow-up thoracic CT in patients with BHD, and pulmonary function had slightly deteriorated by longitudinal follow-up PFT.