切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (06) : 352 -359. doi: 10.3877/cma.j.issn.1674-6899.2024.06.006

论著

支气管镜下单向活瓣肺减容术疗效分析:多中心回顾性研究
朱强1, 喻航1, 郭明学1, 徐轶1, 朱明辉2, 遆新宇3, 李王平4, 徐浩5, 黄勇6, 吴海洪7, 周云芝8, 顾晔9, 梁志欣1, 杨震1, 陈良安1,()   
  1. 1.100853 北京,中国人民解放军总医院第八医学中心呼吸与危重症医学部
    2.430071 武汉大学中南医院胸外科
    3.710005 西安,空军军医大学附属第一医院呼吸与危重症医学科
    4.710038 西安,空军军医大学附属第二医院呼吸科
    5.310009 杭州,浙江大学第二附属医院呼吸科
    6.400799 重庆市人民医院呼吸与危重症医学科
    7.570311 海口,海南省人民医院呼吸与危重症医学科
    8.100028 北京煤炭总医院呼吸科
    9.200433 上海市肺科医院内镜中心
  • 收稿日期:2024-11-27 出版日期:2024-12-30
  • 通信作者: 陈良安
  • 基金资助:
    国家自然科学基金(82070040)

Efficacy of bronchoscopic lung volume reduction with one-way valve:a multicenter retrospective study

Qiang Zhu1, Hang Yu1, Mingxue Guo1, Yi Xu1, Minghui Zhu2, Xinyu Ti3, Wangping Li4, Hao Xu5, Yong Huang6, Haihong Wu7, Yunzhi Zhou8, Ye Gu9, Zhixin Liang1, Zhen Yang1, Liang′an Chen1,()   

  1. 1.The Eighth Medical Center of the Chinese PLA General Hospital,Beijing 100853,China
    2.Department of Thoracic Surgery,Zhongnan Hospital of Wuhan University,430071,China
    3.Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Air Force Medical University,Xi′an 710005,China
    4.Department of Respiratory Medicine,The Second Affiliated Hospital of Air Force Medical University,Xi′an 710038,China
    5.Department of Respiratory Medicine,The Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China
    6.Department of Respiratory and Critical Care Medicine,Chongqing General Hospital,400799,China
    7.Department of Respiratory and Critical Care Medicine,Hainan General Hospital,Haikou 570311,China
    8.Department of Respiratory Medicine,Beijing Meitan General Hospital,100028,China
    9.Endoscopy Center,Shanghai Pulmonary Hospital,200433,China
  • Received:2024-11-27 Published:2024-12-30
  • Corresponding author: Liang′an Chen
引用本文:

朱强, 喻航, 郭明学, 徐轶, 朱明辉, 遆新宇, 李王平, 徐浩, 黄勇, 吴海洪, 周云芝, 顾晔, 梁志欣, 杨震, 陈良安. 支气管镜下单向活瓣肺减容术疗效分析:多中心回顾性研究[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(06): 352-359.

Qiang Zhu, Hang Yu, Mingxue Guo, Yi Xu, Minghui Zhu, Xinyu Ti, Wangping Li, Hao Xu, Yong Huang, Haihong Wu, Yunzhi Zhou, Ye Gu, Zhixin Liang, Zhen Yang, Liang′an Chen. Efficacy of bronchoscopic lung volume reduction with one-way valve:a multicenter retrospective study[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(06): 352-359.

目的

回顾性分析接受支气管镜下单向活瓣(endobronchial valve,EBV)肺减容术治疗的重度肺气肿患者的肺功能、运动耐力、临床症状、生活质量改善情况,评估EBV 治疗重度肺气肿患者的临床疗效。

方法

选取2010年9月至2022年10月间于全国15 家医院接受EBV 治疗的重度肺气肿患者,收集临床资料和胸部高分辨CT(high-resolution computed tomography,HRCT)影像数据,建立临床数据库和影像数据库,对EBV 治疗前后肺功能、运动耐力、临床症状、生活质量改善情况进行评估。

结果

本研究共纳入接受EBV 治疗的重度肺气肿患者136 例(男131 例,女5 例;年龄60 ±8 岁),治疗后患者肺功能、运动耐力、临床症状和生活质量显著改善。 EBV 术后靶肺叶显著减容(靶肺叶减容量,target lobe volume reduction,TLVR≥350 ml)率为64.71%,第1 秒用力呼气量(forced expiratory volume in 1 second,FEV1)显著改善(术后较基线改善≥12%)率为55.15%。 TLVR≥350 ml患者比TLVR <350 ml 患者FEV1 改善更显著( +0.17 L vs. +0.03 L, P <0.001),但36.36%的TLVR≥350 ml 患者未获得FEV1 显著改善。

结论

EBV 治疗能够改善重度肺气肿患者的肺功能、运动耐力、临床症状和生活质量,其总体疗效值得肯定,但临床显著改善患者比例不高。

Objective

To assess the impact of endobronchial valve (EBV) treatment on lung function,exercise tolerance,clinical symptoms,and quality of life in patients with advanced emphysema,and to evaluate the clinical efficacy of EBV in patients with severe emphysema.

Method

From Sep. 2010 to Oct. 2022,patients with advanced emphysema who received EBV treatment in 15 hospitals in China were enrolled in this study. Clinical data and chest high-resolution CT imaging data were collected and used to establish a clinical database and an imaging database. The changes in lung function,exercise tolerance,clinical symptoms,and quality of life before and after treatment were analysed and the response rate of EBV treatment was calculated.

Result

136 patients diagnosed with advanced emphysema who received EBV treatment were included in this study. Of these patients,131 were male and 5 were female,with an average age of 60 ±8 years. The results indicated a significant improvement in the patients′ pulmonary function,exercise tolerance,clinical symptoms,and quality of life following treatment. Additionally,64.71% of cases had a TLVR≥350 ml,and 55.15% of cases achieved the minimal clinically important difference (MCID)in FEV1 improvement (≥12%). EBV efficacy was more pronounced in patients with TLVR≥350 ml,but 36.36% of patients with significant volume reduction did not obtain significant improvement in FEV1.

Conclusion

EBV treatment can improve lung function,exercise tolerance,clinical symptoms,and quality of life in patients with advanced emphysema. However,treatment response rates are still unsatisfactory.

图1 全肺及左右肺区域分割 注:A、D. 在CT 水平面和冠状面图像中,分别标记左右肺、气管区域,软件自动识别并分割全肺、左右肺区域;B ~C、E ~F. 全肺及左右肺分割结果,黄色代表左肺,绿色代表右肺
图2 肺叶区域分割及三维重建 注:A、D.在CT 矢状面图像中,分别在右斜裂、右水平裂、左斜裂标点,软件自动识别叶间裂并完成肺叶分割;B ~C、E ~F. 肺叶分割结果:蓝色代表右上叶、红色代表右中叶、绿色代表右下叶、青色代表左上叶、黄色代表左下叶
表1 患者基本情况
表2 EBV 治疗前后临床疗效指标比较
疗效指标 EBV治疗前 EBV治疗后 改变值 P
靶肺叶容积(n=136) 1.64[1.14,2.04] 0.86[0.25,1.59] -0.61[-1.03,-0.13] <0.001
肺功能(n=136)
FEV1(L) 0.71[0.57,1.01] 0.84[0.67,1.12] 0.11[-0.02,0.25] <0.001
FEV1(%预计值) 26.30[20.15,37.10] 29.66[23.68,41.62] 3.38[-0.33,8.20] <0.001
FVC(L) 2.11±0.74 2.36±0.69 0.26±0.58 <0.001
FVC(%预计值) 62.25[41.98,74.65] 67.59±19.03 9.40[-2.74,17.50] <0.001
FEV1/FVC(%) 36.80[31.91,45.86] 38.44[31.90,45.20] 0.55[-2.06,5.05] 0.153
RV(L) 6.19[5.22,6.80] 5.71±1.14 -0.40[-0.77,-0.04] <0.001
RV(%预计值) 271.4[235.1,298.8] 255.7[227.4,274.0] -20.97[-38.20,-0.98] <0.001
TLC(L) 8.86[8.25,9.45] 8.71[7.88,9.36] -0.14[-0.62,0.12] <0.001
TLC(%预计值) 147.0[134.5,156.4] 141.4[131.0,151.5] -5.50[-13.70,0.68] <0.001
RV/TLC(%) 69.66[65.88,73.13] 67.06[62.75,70.61] -2.61[-5.53,0.40] <0.001
RV/TLC(%预计值) 180.4[165.2,188.6] 175.1[165.2,181.9] -7.84[-16.04,2.40] <0.001
6MWD(m,n=136) 268.1±76.5 306.7±92.9 38.6±54.5 <0.001
mMRC评分(n=95) 3.00[2.00,3.25] 2.00[1.75,3.00] -1.00[-2.00,0.00] <0.001
SGRQ评分(n=95) 56.27±13.74 49.31[41.34,57.67] -4.38[-7.94,-0.24] <0.001
BODE评分(n=86) 6.00[5.00,8.00] 5.00[4.00,6.00] -1.00[-2.00,0.00] <0.001
CAT评分(n=63) 23.00[19.75,26.00] 18.00[15.00,21.00] -4.00[-7.25,-2.00] <0.001
表3 根据不同疗效指标计算的MCID 达标率
表4 以TLVR MCID 分组的EBV 疗效比较
疗效指标 TLVR≥350 ml(n=88) TLVR<350 ml(n=48) 改善值组间差异 组间P
治疗前后改善值 P 治疗前后改善值 P
FEV1(L) 0.17[0.02,0.27] <0.001 0.03[-0.10,0.18] 0.322 0.14[-0.08,0.34] 0.001
FEV1(%预计值) 6.10[1.20,10.18] <0.001 1.55[-3.07,6.40] 0.284 5.25[-0.84,12.33] <0.001
FVC(L) 0.45[-0.02,0.66] <0.001 0.15[-0.27,0.47] 0.110 0.24[-0.27,0.82] 0.035
FVC(%预计值) 11.30[0.60,17.51] <0.001 5.60[-6.75,13.68] 0.105 6.60[-7.08,21.07] 0.066
FEV1/FVC(%) 2.60[-1.40,5.98] 0.003 -0.55[-6.15,2.05] 0.077 4.30[-1.87,8.18] 0.001
RV(L) -0.58[-1.05,-0.16] <0.001 -0.20[-0.42,0.20] 0.629 -0.46[-1.08,0.14] <0.001
RV(%预计值) -26.44[-48.50,-12.78] <0.001 -9.59[-22.96,17.25] 0.353 -21.54[-54.53,-0.94] <0.001
TLC(L) -0.32[-0.93,-0.03] <0.001 -0.01[-0.18,0.21] 0.748 -0.40[-1.20,-0.02] <0.001
TLC(%预计值) -7.76[-15.60,-0.63] <0.001 -0.75[-9.29,2.61] 0.371 -7.95[-19.07,3.23] 0.005
RV/TLC(%) -4.11[-6.42,-0.77] <0.001 -1.08[-2.95,0.96] 0.117 -3.58[-6.59,1.82] <0.001
RV/TLC(%预计值) -11.39[-16.91,0.02] <0.001 -1.80[-8.82,8.27] 0.798 -8.61[-21.02,2.37] 0.001
6MWD(m) 50.20±50.99 <0.001 17.29±30.61 <0.001 34.00[-18.00,70.75] 0.002
SGRQ评分(95例) -5.41[-12.30,-1.26] <0.001 -3.46[-5.33,1.51] 0.066 -3.61[-10.68,1.75] <0.001
mMRC评分(95例) -1.00[-2.00,0.00] <0.001 0.00[-1.00,1.00] 0.541 -1.00[-2.00,0.00] <0.001
BODE评分(86例) -2.00[-3.00,0.00] <0.001 -4.00[-7.00,-1.00] 0.696 -1.00[-2.00,0.00] <0.001
表5 以TLVR MCID 分组下的显著改善率
1
GBD 2013 Mortality and Causes of Death Collaborators. Global,regional,and national age-sex specific all-cause and cause-specific mortality for 240 causes of death,1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet,2015,385(9963):117-171.
2
龙政,刘威,齐金蕾,等. 1990-2019年中国慢性呼吸系统疾病死亡情况及变化趋势[J]. 中华流行病学杂志,2022,43:14-21.
3
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention and management of COPD: 2024 Report[EB/OL]. 2024.
4
中华医学会呼吸病学分会慢性阻塞性肺疾病学组,中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志,2021,44(3):170-205.
5
Nici L,Mammen MJ,Charbek E,et al. Pharmacologic management of chronic obstructive pulmonary disease. an official american thoracic society clinical practice guideline[J]. Am J Respir Crit Care Med,2020,201(9):e56-e69.
6
Sciurba FC,Ernst A,Herth FJ,et al. A randomized study of endobronchial valves for advanced emphysema[J]. N Engl J Med,2010,363(13):1233-1244.
7
Li S,Wang G,Wang C,et al. The REACH trial: a randomized controlled trial assessing the safety and effectiveness of the spiration?Valve system in the treatment of severe emphysema [ J].Respiration,2019,97(5):416-427.
8
Deslée G,Mal H,Dutau H,et al. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical trial[J]. JAMA,2016,315(2):175-184.
9
Herth FJ,Valipour A,Shah PL,et al. Segmental volume reduction using thermal vapour ablation in patients with severe emphysema:6-month results of the multicentre,parallel-group,open-label,randomised controlled STEP-UP trial[J]. Lancet Respir Med,2016,4(3):185-193.
10
ComeCE,Kramer MR,Dransfield MT,et al. A randomised trial of lung sealant versus medical therapy for advanced emphysema[J].Eur Respir J,2015,46(3):651-162.
11
Shah PL,Herth FJ,van Geffen WH,et al. Lung volume reduction for emphysema[J]. Lancet Respir Med,2017,5(2):147-156.
12
Hellmann F,Verdi M,Schlemper BR Jr,et al. 50th anniversary of the Declaration of Helsinki: the double standard was introduced[J]. Arch Med Res,2014,45(7):600-601.
13
HARVARD UNIVERSITY. Chest Imaging Platform (CIP) [EB/OL]. [2024/02/24 Accessed].
14
Jaeschke R,Singer J,Guyatt GH. Measurement of health status.Ascertaining the minimal clinically important difference[J]. Control Clin Trials,1989,10(4):407-415.
15
Sedaghat AR. Understanding the minimal clinically important difference (MCID) of patient-reported outcome measures [J].Otolaryngol Head Neck Surg,2019,161(4):551-560.
16
Pellegrino R,Viegi G,Brusasco V,et al. Interpretative strategies for lung function tests[J]. Eur Respir J,2005,26(5):948-968.
17
Park TS,Hong Y,Lee JS,et al. Bronchoscopic lung volume reduction by endobronchial valve in advanced emphysema: the first Asian report[J]. Int J Chron Obstruct Pulmon Dis,2015,10:1501-1511.
18
Posthuma R,Vaes AW,Walraven KHM,et al. Implementation of bronchoscopic lung volume reduction using one-way endobronchial valves: a retrospective single-centre cohort study[J]. Respiration,2022,101(5):476-484.
19
Dumanli A,Metin B,Gunay E. Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey[J]. Ann Saudi Med,2020,40(6):469-476.
20
Sidhu C,Wilsmore N,Shargill N,et al. Lung volume reduction for emphysema using one-way endobronchial valves: an Australian cohort[J]. Medicine (Baltimore),2023,102(31):e34434.
21
Yu H,Yang Z,Zhu M,et al. Endobronchial valve therapy for patients with advanced emphysema. A report from a tertiary care center in China[J]. Saudi Med J,2022,43(12):1397-1401.
22
Hopkinson NS,Kemp SV,Toma TP,et al. Atelectasis and survival after bronchoscopic lung volume reduction for COPD[J]. Eur Respir J,2011,37(6):1346-1351.
23
Valipour A,Herth FJ,Burghuber OC,et al. Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy[J]. Eur Respir J,2014,43(2):387-396.
24
van Dijk M,Klooster K,Hartman JE,et al. Change in dynamic hyperinflation after bronchoscopic lung volume reduction in patients with emphysema[J]. Lung,2020,198(5):795-801.
25
Fumat R,Dupuis M,Mallah S,et al. Impact of bronchoscopic lung volume reduction with endobronchial valves on dynamic hyperinflation: results from the PIERCE study[J]. Respirology,2023,28(6):525-532.
26
Pizarro C,Schueler R,Hammerstingl C,et al. Impact of endoscopic lung volume reduction on right ventricular myocardial function[J]. PLoS One,2015,10(4):e0121377.
27
Fiorelli A,Cascone R,Natale G,et al. Cardio-pulmonary changes after bronchoscopic lung volume reduction with endobronchial oneway valves[J]. Lung,2020,198(3):565-573.
28
van der Molen MC,Hartman JE,Vanfleteren LEGW,et al.Reduction of lung hyperinflation improves cardiac preload,contractility,and output in emphysema: a clinical trial in patients who received endobronchial valves[J]. Am J Respir Crit Care Med,2022,206(6):704-711.
29
Wallbridge P,Hew M,Parry SM,et al. Reduction of COPD hyperinflation by endobronchial valves improves intercostal muscle morphology on ultrasound[J]. Int J Chron Obstruct Pulmon Dis,2020,15:3251-3259.
30
Brindel A,Fumat R,Dupuis M,et al. Bronchoscopic lung volume reduction with endobronchial valves improves respiratory muscle function in patients with severe emphysema[J]. Respir Med Res,2023,84:101030.
31
Davey C,Zoumot Z,Jordan S,et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures ( the BeLieVeR-HIFi study): a randomised controlled trial[J]. Lancet,2015,386(9998):1066-1073.
32
Welling JBA,Hartman JE,van Rikxoort EM,et al. Minimal important difference of target lobar volume reduction after endobronchial valve treatment for emphysema[J]. Respirology,2018,23(3):306-310.
33
Hopkinson NS,Toma TP,Hansell DM,et al. Effect of bronchoscopic lung volume reduction on dynamic hyperinflation and exercise in emphysema[J]. Am J Respir Crit Care Med,2005,171(5):453-460.
[1] 陈腊青, 林佳佳, 毛洪刚, 童冠海, 汪梦娜, 夏红波, 刘卓, 徐海霞, 赵玉华, 张传领. 血清细胞因子及呼出气一氧化氮在哮喘-慢性阻塞性肺疾病重叠综合征中的临床意义[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(04): 316-320.
[2] 刘佳敏, 谢逍, 李梅. 纤维支气管镜联合氨溴索治疗COPD伴呼吸衰竭疗效及对血气指标、肺功能和血乳酸水平的影响[J/OL]. 中华肺部疾病杂志(电子版), 2023, 16(05): 640-644.
[3] 张江松, 张颖, 胡熠. ACOS患者FeNO水平与肺功能及血清EOS、CRP、ESR的相关性[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(06): 819-821.
[4] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[5] 贾玲玲, 滕飞, 常键, 黄福, 刘剑萍. 心肺康复在各种疾病中应用的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 859-862.
[6] 闫维, 张二明, 张克, 安欣华, 向平超. 北京市石景山区40岁及以上居民早期慢性阻塞性肺疾病异质性及影响因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 533-540.
[7] 张克, 张二明, 闫维, 马石头, 安欣华, 包曹歆, 向平超. 北京石景山区40岁以上PRISm和COPD患者的肺功能水平与吸烟情况相关性分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(02): 122-127.
[8] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J/OL]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[9] 孙培培, 张二明, 时延伟, 赵春燕, 宋萍萍, 张硕, 张克, 周玉娇, 赵璨, 闫维, 吴蓉菊, 宋丽萍, 郭伟安, 马石头, 安欣华, 包曹歆, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病患病情况及相关危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2023, 17(06): 711-719.
[10] 魏巍, 王颖, 许迪, 刘璐, 黄秀凤, 陈志海, 张钰. 慢性阻塞性肺疾病患者步态分析的初步研究[J/OL]. 中华临床医师杂志(电子版), 2022, 16(06): 501-506.
[11] 李坤徉, 张莉. 慢性阻塞性肺疾病急性加重并发糖尿病的危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2022, 16(06): 493-500.
[12] 陈名珍, 杨珺楠, 李开来, 赵旭静, 薛安静, 满姗姗, 向平超. 经鼻高流量氧气湿化治疗老年慢性阻塞性肺疾病急性加重合并呼吸衰竭的可行性研究[J/OL]. 中华临床医师杂志(电子版), 2022, 16(06): 481-486.
[13] 赵璨, 孙培培, 张二明, 安欣华, 马石头, 刘力勇, 向平超. 北京十家社区40岁及以上居民吸烟、二手烟暴露与慢性阻塞性肺疾病的关系[J/OL]. 中华临床医师杂志(电子版), 2021, 15(06): 450-458.
[14] 王敏, 张妍, 王盈熹, 赵龙, 夏书月. 外泌体在慢性阻塞性肺疾病中的作用[J/OL]. 中华临床实验室管理电子杂志, 2023, 11(01): 45-51.
[15] 何秀, 敖的, 杨郑, 林小华. 改良呼吸支持策略对慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者的疗效[J/OL]. 中华卫生应急电子杂志, 2024, 10(03): 140-144.
阅读次数
全文


摘要