《慢性阻塞性肺疾病全球创议(2024版)》解读:慢性阻塞性肺疾病合并肺间质异常临床评估、危险分层以及预后

Interpretation of the Global Initiative for Chronic Obstructive Lung Disease(2024 report):clinical evaluation,risk stratification,and prognosis of chronic obstructive pulmonary disease with pulmonary interstitial abnormalities

《慢性阻塞性肺疾病全球创议(2024版)》首次提出肺间质异常(ILA)是吸烟者和非吸烟者胸部CT上常见的影像学表现。因ILA可能与不良预后相关,有必要对表现有ILA的个体进行临床评估、风险分层和随访监测。本文回顾了目前慢性阻塞性肺疾病(慢阻肺)合并ILA的研究现状和进展。ILA可导致呼吸道症状增加、活动耐力下降、肺功能下降,并与不良预后和病死率升高相关。吸烟和衰老是慢阻肺与ILA共同的危险因素,ILA在慢阻肺中的患病率高于一般人群。ILA对慢阻肺的临床表现、预后有不良的影响,可能导致慢阻肺患者肺通气功能和肺容量的假性正常化,而弥散功能可能进一步下降。由于ILA与慢阻肺对肺功能可能有相反的影响,在两种疾病合并存在时,评估肺功能的改变需要仔细考量ILA和慢阻肺/肺气肿的严重程度,并应考虑到第1秒用力呼气容积/用力肺活量有假性正常的可能。

The Global Initiative for Chronic Obstructive Lung Disease(GOLD)(2024)report proposed for the first time that interstitial lung abnormalities(ILA)is common on CT imaging of both smokers and nonsmokers.As ILA maybe associated with poor prognosis,it is necessary to conduct clinical evaluation,risk stratification,and follow-up monitoring of the individuals with ILA.This article reviewed the research progress in COPD combined with ILA.ILA is associated with increased respiratory symptoms,decreased activity tolerance,decreased lung function,poor prognosis,and increased mortality.Smoking and aging are risk factors for both COPD and ILA,and the prevalence of ILA in COPD was higher than that in the general population.ILA has adverse impacts on the clinical manifestations and outcomes of COPD,may pseudo-normalize the ventilation function and lung volume in COPD patients and aggravate the decrease in diffusion function.Due to the potential opposite effects of ILA and COPD on pulmonary function,the severity of ILA and COPD/emphysema should be considered when evaluating the pulmonary function in COPD combined with ILA,and the possibility of a pseudo-normalized forced expiratory volume in one second(FEVi)/forced vital capacity(FVC)should be taken into account.