计算机断层扫描(CT)通常用于慢性阻塞性肺疾病(COPD)的肺癌筛查和肺气肿表征。身体成分(肌肉质量和肥胖)的计算机断层扫描-形态测量分析作为疾病严重程度和预后的标志已获得越来越多的认可。本系统综述旨在描述用于评估身体成分的CT方法,并确定身体成分测量与疾病严重程度的关联。健康相关生活质量(HRQL),心脏代谢危险因素,呼吸恶化,COPD患者的生存率。
检索了6个数据库(开始时间-2021年9月),用于使用胸部或腹部CT肌肉或肥胖身体成分测量来评估成年COPD患者的研究。系统审查是根据PRISMA指南进行的。
共纳入28篇15,431例COPD患者,在所有黄金阶段,男性占77%,年龄范围(平均/中位数59-78岁),BMI范围为19.8-29.3kg/m2。使用胸部(n=22)和腹部(n=8)CT扫描评估肌肉质量和肥胖存在异质性,捕捉不同的肌肉群,解剖位置,和肥胖隔室(内脏,皮下,和心外膜)。低肌肉质量和肥胖增加与COPD严重程度增加相关(肺功能,锻炼能力,呼吸困难)和较低的HRQL,但在研究中并不一致。内脏肥胖增加(n=6)与心血管疾病或危险因素(高血压,高脂血症,和糖尿病)。在六项研究中的三项中,低肌肉CSA是呼吸加重或死亡的预后。而仅在三项研究中的一项中观察到与肌间肥胖增加和死亡率增加的关系。
在CT-身体成分测量中存在显著的变异性。在一些研究中,低肌肉质量与疾病严重程度增加和HRQL降低相关,而肥胖与心血管疾病/危险因素。鉴于身体成分测量和临床结果的异质性,CT-体成分在COPD中的预后效用需要进一步研究.
Computed tomography (CT) is commonly utilized in chronic obstructive pulmonary disease (COPD) for lung cancer screening and emphysema characterization. Computed tomography-morphometric analysis of body composition (muscle mass and adiposity) has gained increased recognition as a marker of disease severity and prognosis. This systematic
review aimed to describe the CT-methodology used to assess body composition and identify the association of body composition measures and disease severity, health-related quality of life (HRQL), cardiometabolic risk factors, respiratory exacerbations, and survival in patients with COPD.
Six databases were searched (inception-September 2021) for studies evaluating adult COPD patients using thoracic or abdominal CT-muscle or adiposity body composition measures. The systematic
review was conducted in accordance with the PRISMA guidelines.
Twenty eight articles were included with 15,431 COPD patients, across all GOLD stages with 77% males, age range (mean/median 59-78 years), and BMI range 19.8-29.3 kg/m2. There was heterogeneity in assessment of muscle mass and adiposity using thoracic (n = 22) and abdominal (n = 8) CT-scans, capturing different muscle groups, anatomic locations, and adiposity compartments (visceral, subcutaneous, and epicardial). Low muscle mass and increased adiposity were associated with increased COPD severity measures (lung function, exercise capacity, dyspnea) and lower HRQL, but were not consistent across studies. Increased visceral adiposity (n = 6) was associated with cardiovascular disease or risk factors (hypertension, hyperlipidemia, and diabetes). Low muscle CSA was prognostic of respiratory exacerbations or mortality in three of six studies, whereas the relationship with increased intermuscular adiposity and greater mortality was only observed in one of three studies.
There was significant variability in CT-body composition measures. In several studies, low muscle mass was associated with increased disease severity and lower HRQL, whereas adiposity with cardiovascular disease/risk factors. Given the heterogeneity in body composition measures and clinical outcomes, the prognostic utility of CT-body composition in COPD requires further study.