고해상능 전산화단층촬영을 이용한 폐기종 정량분석의 유용성 : 폐기능 검사와의 비교

임상묵(Sang Muk Im),이우식(Woo Sik Lee),구양수(Yang Su Goo),이강우(Kang Woo Lee),조영기(Young Ki Cho),강화원(Hwa Won Kang),최창한(Chang Han Choi),이광원(Kwang Won Lee),김동수(Dong Su Kim) 대한전산화단층기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

Purpose The pathological severity of emphysema can be detected in high resolution CT well. We obtained mean lung density at inspiratory and expiratory, and percentage of emphysema subrange per slice through Quantitative emphysema CT. We tried to know the usability of Quantitative analysis in emphysema CT, the correlation between results of Quantitative emphysema CT and results of pulmonary function test such as forced vital capacity and forced expiratory volume in one second. Materials and Methods For this study, we selected 10 emphysema patients who had been found to have emphysema through high resolution CT and pulmonary function test during the period from june to august 2005, and who did not have accompanying diseases except emphysema. Also we selected 10 normal persons as a control group who did not have any history clinical disease or smoking in the past. In high resolution CT, we scanned the whole lungs on full inspiration and full expiration at slice thickness of 1mm and at intervals of 10mm using Somatom Sensation 16 with exposure conditions of 140kVp, 160mAs and algorithm B70 ultra sharp. In addition, we measured the area of emphysema by summing values obtained from each section through measuring the CT value inside the parenchyma of the lungs using a Quantitative CT software program. And calculated mean lung density and subrange percentage in the control group and the emphysema patient group on full inspiration and full expiration at pulmonary function test, and determined significance among them. Moreover, we compared forced vital capacity, which was an index of pulmonary function test for the emphysema patients, and forced expiratory capacity in one second for the emphysema patient group and analyzed significant differences using SPSS 10.0. Results Mean lung density of the emphysema patient group on full inspiration and that on full expiration were 895.59HU and 861.45HU, respectively, and their subrange percentages were 63% and 50%, respectively. Statistically significant differences were observed between the control group and the emphysema group in mean lung density and subrange percentage on full inspiration and full expiration. According to the result of analyzing the correlation of mean lung density and subrange percentage in the emphysema patient groups with the indexes of pulmonary function test such as forced vital capacity and forced expiratory volume in one second, statistically significant differences were observed in one second forced expiratory volume according to subrange percentage on full expiration. This suggests that quantative CT is a useful test for diagnosing emphysema and it is more effective to examine emphysema patients on full expiration. Conclusion According to the results of quantitative CT on the control group and the emphysema group, significant differences were observed between the groups in pulmonary function test, so the emphysema quantitative CT program appeared useful in analyzing emphysema but it is considered necessary to develop a pulmonary function quantitative CT that can examine patients with maintaining their breathing in a constant state.

Evaluation of Emphysema in Patients with Asthma Using High - resolution CT

(Ki Young Hong),(June Hyuk Lee),(Sung Woo Park),(Jae Hak Joo),(Do Jin Kim),(Sung Heuk Moon),(Soo Taek Uh),(Yong Hoon Kim),(Choon Sik Park),(Jae Seung Park) 대한내과학회 2002 The Korean Journal of Internal Medicine Vol.17 No.1

N/A Background : Bronchial asthma is a clinical syndrome characterized by reversibility of airway obstruction. However, many asthmatics have evidence of residual airway obstruction. It has become evident that the repair of the chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for the change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and mare accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characteristics in asthmatics with emphysema. Methods : We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups : Asthmatics with emphysema and the ones without emphysema. Results : of the 58 patients, 7 were revealed to have emphysema. (1) 6 asthmatics with emphysema were smokers, but one patient was a nonsmoker. (2) Highly significant differences between asthmatics with and without emphysema were found in cigarette smoking (p<0.01) and smoking consumption (p<0.01). (3) There were no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There were no significant differences in FEV1(%), FEV1/FVC(%), diffusing capacity for carbon monoxide (DLco) (%) and DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickeness (p<0.05) and in total Ig E levels (p=0.07). Conclusion : These results indicate that smoking is a main factor in causing emphysema in asthmatics.

천식 환자에서 고해상 흉부 단층 촬영을 이용한 폐기종의 평가

김용훈(Yong Hoon Kim),류은상(Eun Sang Ryoo),홍기영(Ki Young Hong),이준혁(June Hyuk Lee),이태영(Tae Young Lee),서문정(Moon Jung Seo),주재학(Jae Hak Joo),김도진(Do Jin Kim),문승혁(Sung Heuk Moon),어수택(Soo Teak Uh),박춘식(Choon Sik Pa 대한내과학회 2001 대한내과학회지 Vol.60 No.5

N/A Background : Bronchial asthma is a clinical syndrome characterized by reversiblity of airway obstruction. however, many asthma patients have evidence of residual airway obstruction. It has become evident that the repair of chronic inflammatory process can lead to various irreversible changes. It is generally accepted that the most common cause for change is cigarette smoking but it is controversial whether asthma progresses to emphysema. High resolution computed tomography (HRCT) is more sensitive and more accurate than chest plain films in determining the type and extent of emphysema. This study was carried out to determine whether asthma can be a cause of emphysema without the effect of cigarette smoking and to evaluate clinical characterics in asthma patients with emphysema. Methods : We studied 58 asthmatic patients with reversible airway obstruction and evaluated the presence of emphysema using HRCT and pulmonary function test. According to HRCT findings, they were divided into 2 groups: Asthma patients with and without emphysema. Results : Of the 58 patients, 7 were judged to have emphysema. (1) 6 asthma patients with emphysema were smokers, but one patient was nonsmoker. (2) Highly significant differences between patients with and without emphysema were found in cigarette smoking (p<0.01), smoking consumption (p<0.01). (3) There was no significant differences in the duration of asthma, age or sex between patients with and without emphysema. (4) There was no significant differences in FEV1 (%), FEV1/FVC (%), diffusing capacity for carbon monoxide (DLco) (%), DLco/alveolar volume between patients with and without emphysema (5) Differences between asthma patients without emphysema and those with emphysema were found to be significant in bronchial wall thickening (p<0.05) and in total Ig E (p=0.07). Conclusion : These results indicate that smoking is a main factor to cause emphysema in the patient with asthma.(Korean J Med 60:463-471, 2001)

Clinical Relevance of Emphysema in Patients Hospitalized with Community-acquired Pneumonia: Clinical Features and Prognosis

( Hyewon Seo ),( Seung-ick Cha ),( Ji-eun Park ),( Sunji Park ),( Sun Ha Choi ),( Yong-hoon Lee ),( Seung-soo Yoo ),( Shin-yup Lee ),( Jaehee Lee ),( Chang-ho Kim ),( Jae-yong Park ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

Introduction Few studies have investigated the influence of emphysema on clinical features of patients presenting with community-acquired pneumonia (CAP). Objectives: The aim of this study was to examine the clinical and microbiological features of patients with both CAP and emphysema. Methods This retrospective study included patients with CAP who underwent computed tomography (CT) scan at the time of presentation. Patients were allocated into emphysema and control groups, and clinical variables were compared between the 2 groups. The emphysema group was further divided into 3 subgroups (mild, moderate, and severe) according to the extent of emphysema on CT scan. The clinical variables of each subgroup were compared with the control group. Results Of 1676 patients, 431 patients (25.7%) were classified into the emphysema group. CAP patients with emphysema were more likely to have a high CURB-65 score and pneumonia severity index and a lower incidence of complicated parapneumonic effusion or empyema. The emphysema group exhibited longer hospital stay. In addition, 30-day mortality in the severe emphysema group was significantly higher compared with the control group. As etiological agents, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterobacteriaceae, and multi-drug resistant pathogens were significantly more common in the emphysema group compared with the control group. Conclusion The presence of emphysema in CAP patients was associated with a more severe form of CAP, a longer hospital stay, and a lower incidence of complicated parapneumonic effusion or empyema. Moreover, CAP patients with severe emphysema exhibited higher 30-day mortality than those without emphysema.

The Association between Soluble Receptor for Advanced Glycation End Products (sRAGE) and Emphysema: Is the Treatment with sRAGE for Emphysema only Valid in the Specific Polymorphism of AGER Gene?

( Sooim Sin ),( Woo Jin Kim ),( Myung Nam Im ),( So Hyeon Bak ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Purpose Higher soluble receptor for advanced glycation end products (sRAGE) levels are considered to be associated with severe emphysema. However, the relationship between sRAGE, emphysema and the polymorphism of rs2070600 in advanced glycation end-product specific receptor (AGER) gene remains uncertain. To investgate the relationship, we analyzed association of sRAGE and emphysema according to the genotypes of rs2070600. Methods We genotyped rs2070600 polymorphism in participants. Plasma concentration of sRAGE was measured using enzyme-linked immunosorbent assay. Emphysema was quantified based on chest computer tomography of each participant. We compared level of sRAGE according to presence and severity of emphysema in each genotype. Moreover, we used multiple logistic regression and linear regression model for control covariates. Results In total, 436 participants were included in this study. Among them, 280 (64.2%) were chronic obstructive pulmonary disease (COPD) patients and 166 (38.1%) had emphysema. The level of sRAGE was significantly high in participants without emphysema compared to those with emphysema in COPD patients with CC genotype (P<0.0001). Also, the level of sRAGE was negatively correlated with emphysema severity in COPD patients with CC genotype (r=-0.295, P<0.0001). Multiple regression analysis revealed that sRAGE was independent protective factor for presence of emphysema (odds ratio 0.257 CI, 0.120-0.551) and severity of emphysema (β=-3.289, P<0.001) in CC genotyped participants after adjusting age, sex, smoking status, body mass index and presence of COPD. Conclusion Plasma sRAGE might be a biomarker with protective effect on emphysema in certain subgroup, COPD patients with CC genotype of rs2070600 on AGER gene. This is important in determining the target group for future treatment for emphysema.

Emphysema as a Risk Factor for the Outcome of Surgical Resection of Lung Cancer

이성아,선주성,박주헌,박경주,이성수,최호,신승수,정우영,이규성,박광주,황성철 대한의학회 2010 Journal of Korean medical science Vol.25 No.8

It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2±3.0 vs. 40.6±3.1 months,P=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV1/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.

Emphysema as a Risk Factor for the Outcome of Surgical Resection of Lung Cancer

Lee, Sung Ah,Sun, Joo Sung,Park, Joo Hun,Park, Kyung Joo,Lee, Sung Soo,Choi, Ho,Sheen, Seung Soo,Chung, Woo Young,Lee, Keu Sung,Park, Kwang Joo,Hwang, Sung Chul The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.8

<P>It is unclear whether emphysema, regardless of airflow limitation, is a predictive factor associated with survival after lung cancer resection. Therefore, we investigated whether emphysema was a risk factor associated with the outcome after resection for lung cancer. This study enrolled 237 patients with non small cell lung cancer with stage I or II who had surgical removal. Patient outcome was analyzed based on emphysema. Emphysema was found in 43.4% of all patients. Patients with emphysema were predominantly men and smokers, and had a lower body mass index than the patients without emphysema. The patients without emphysema (n=133) survived longer (mean 51.2±3.0 vs. 40.6±3.1 months, <I>P</I>=0.042) than those with emphysema (n=104). The univariate analysis showed a younger age, higher FEV<SUB>1</SUB>/FVC, higher body mass index, cancer stage I, and a lower emphysema score were significant predictors of better survival. The multivariate analysis revealed a younger age, higher body mass index, and cancer stage I were independent parameters associated with better survival, however, emphysema was not. This study suggests that unfavorable outcomes after surgical resection of lung cancer should not be attributed to emphysema itself.</P>

HRCT Emphysema Scoring과 운동부하 폐기능검사 지표들 간의 상관관계

최은경,최영희,김도형,김용호,윤세영,박재석,김건열,이계영,Choi, Eun-Kyoung,Choi, Young-Hee,Kim, Doh-Hyung,Kim, Yong-Ho,Yoon, Se-Young,Park, Jae-Seuk,Kim, Keun-Youl,Lee, Kye-Young 대한결핵및호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.50 No.4

배 경 : 폐기종의 중증도 판정에 있어서 병리학적 기준은 기강(air space)의 확장 정도에 있으며, 이는 고해상도 전산화 촬영 (high resolution computed tomography, HRCT)에 의해 결정되는 폐기종 점수(emphysema scoring)와 좋은 상관성을 보인다는 것은 주지의 사실이다. 한편 폐기종의 주증상은 운동성 호흡곤란이므로 폐기종에 대한 임상적 평가는 운동능력의 감소를 측정하는 것이 타당하다고 알려져 있다. 그러나 대개의 경우 폐기종의 중증도 판정은 안정시 폐기능 검사에 의존하는 경우가 흔하며, 병리학적 중증도 판정과 상관성이 높다고 알려져 있는 고해상도 전산화 촬영에 의한 폐기종 점수와 운동부하 폐기능검사 지표들과의 상관성 여부에 대한 연구는 드문 실정이다. 이에 본 연구에서는 폐기종의 중증도 판정에 있어서 HRCT와 안정시 폐기능 검사 및 운동부하 폐기능 검사간에 상호 관련성을 확인하여 보았다. 방 법 : 평균 연령 $60.6{\pm}10.3$세인 14명의 폐기종 환자들을 대상으로 HRCT, 안정시 폐기능 검사(forced expiratory flow volume curve, lung volumes by He dilution method, DLco, ABGA), 그리고 점진적운동부하폐 기능검사(incremental cycle ergometer)를 시행하였으며 HRCT는 GE highlight를 이용하여 조영증강 없이 최대흡기시에 1.5mm collimation, 10mm 간격으로 폐전체를 스캔하였고, 환자마다 모든 스캔에서 density mask를 이용하여 -400 HU를 기준으로 한 총폐면적과 -900 HU를 기준으로 한 폐기종 면적을 각각 구하여 백분율로 환산하여 폐기종 점수를 구하였다. 결 과 : 평균 폐기종 점수는 $37.4{\pm}14.9%$ 이었다. 폐기종 점수와 안정시 폐기능 검사의 DLco(r=-0.75)와 $PaO_2$(r=-0.66) 사이에서만 유의한(p<0.05) 상관성이 관찰되었다. 반면 폐기종 점수와 운동부하폐기능 지표들간의 상관성은 최대 산소섭취량(r=-0.68), 혐기성 역치(V-slope method, r=-0.690), 최대운동부하(r=-0.74), 최대운동시 $O_2$ pulse(r=-0.73), 최대운동시의 생리적 사강비율 (r=0.80) 등과 높은 유의성 (p<0.01)을 나타내었다. 그러나 호흡예비율과 심박수 예비율간에서는 유의한 상관성이 없었고, pulse oxymeter로 측정한 산소포화도와의 상관성도 유의하지 않았다. 결 론 : 이상의 결과에서 폐기종의 병리학적 중증도를 잘반영한다고 알려진 HRCT 폐기종 접수는 폐기종에 의한 생리학적 장애를 잘 반영하는 운동부하 폐기능 검사의 주요 지표들과 유의한 상관성이 있음을 확인할 수 있었다. Background : The correlation between the high resolution computed tomography(HRCT) emphysema score and the physiologic parameters including resting and exercise pulmonary function test was investigated in 14 patients($60.6{\pm}10.3$ years) with pulmonary emphysema. Methods : The patients underwent a HRCT, a resting pulmonary function test, and incremental exercise testing(cycle ergometer, 10 W/min). Computed tomography scans were obtained on a GE highlight at 10 mm intervals using 10 mm collimation, from the apex to the base after a full inspiration. The emphysema scores were determined by a CT program 'Density mask' outlining the areas with attenuation values less than -900 HU, indicating the emphysema areas, and providing an overall percentage of lung involvement by emphysema. Results : Among the resting PFT parameters, only the diffusing capacity(r=-0.75) and $PaO_2$ (r=-0.66) correlated with the emphysema score(p<0.05). Among the exercise test parameters, the emphysema score correlated significantly with the maximum power(r=-0.74), maximum oxygen consumption(r=-0.68), anaerobic threshold(V-slope method: r=-0.69), maximal $O_2$-pulse(r=-0.73), and the physiologic dead space ratio at the maximum workload(r=-0.80)(p<0.01). Conclusion: We could find that exercise testing parameters showed a much better correlation with the HRCT emphysema score, which is known to have a good correlation with the pathologic severity than the resting PIT parameters. Therefore it is suggested that exercise testing is superior to resting PIT for estimating in the estimation of the physiologic disturbance in emphysema patients.

Protective effects of basic fibroblast growth factor in the development of emphysema induced by interferon-${\gamma}$

Lee, Byung-Jae,Moon, Hyung-Geun,Shin, Tae-Seop,Jeon, Seong-Gyu,Lee, Eun-Young,Gho, Yong-Song,Lee, Chun-Geun,Zhu, Zhou,Elias, Jack A.,Kim, Yoon-Keun Korean Society for Biochemistry and Molecular Bion 2011 Experimental and molecular medicine Vol.43 No.4

Recent clinical evidence indicates that the non-eosinophilic subtype of severe asthma is characterized by fixed airway obstruction, which may be related to emphysema. Transgenic studies have demonstrated that high levels of IFN-${\gamma}$ in the airways induce emphysema. Fibroblast growth factor 2 (FGF2), which is the downstream mediator of TGF-${\beta}$, is important in wound healing. We investigated the role of FGF2 in IFN-${\gamma}$-induced emphysema and the therapeutic effects of recombinant FGF2 in the prevention of emphysema in a severe non-eosinophilic asthma model. To evaluate the role of FGF2 in IFN-${\gamma}$-induced emphysema, lung targeted IFN-${\gamma}$ transgenic mice were cross-bred with FGF2-deficient mice. A severe non-eosinophilic asthma model was generated by airway application of LPS-containing allergens twice a week for 4 weeks. To evaluate protective effects of FGF2, recombinant FGF2 ($10{\mu}g$) was injected subcutaneously during allergen challenge in the severe asthma model. We found that non-eosinophilic inflammation and emphysema induced by transgenic overexpression of IFN-${\gamma}$ in the airways were aggravated by the absence of FGF2. Airway challenge with LPS-containing allergens induced more inflammation in mice sensitized with LPS-containing allergens compared to challenge with allergens alone. In addition, LPS-induced lung inflammation and emphysema depended on IFN-${\gamma}$ but not on IL-13. Interestingly, emphysema in the severe asthma model was significantly inhibited by treatment with recombinant FGF2 during allergen challenge, whereas lung inflammation was unaffected. Therefore, our present data suggest that FGF2 may help protect against IFN-${\gamma}$-induced emphysema, and that recombinant FGF2 may help lessen the severity of emphysema.

Protective effects of basic fibroblast growth factor in the development of emphysema induced by interferon-γ

이병재,김윤근,Hyung-Geun Moon,Tae-Seop Shin,전성규,Eun-Young Lee,고용송,이춘근,Zhou Zhu,Jack A. Elias 생화학분자생물학회 2011 Experimental and molecular medicine Vol.43 No.4

Recent clinical evidence indicates that the non-eosinophilic subtype of severe asthma is characterized by fixed airway obstruction, which may be related to emphysema. Transgenic studies have demonstrated that high levels of IFN-γ in the airways induce emphysema. Fibroblast growth factor 2 (FGF2), which is the downstream mediator of TGF-β, is important in wound healing. We investigated the role of FGF2 in IFN-γ-induced emphysema and the therapeutic effects of recombinant FGF2 in the prevention of emphysema in a severe non-eosinophilic asthma model. To evaluate the role of FGF2 in IFN-γ-induced emphysema,lung targeted IFN-γ transgenic mice were cross-bred with FGF2-deficient mice. A severe non-eosinophilic asthma model was generated by airway application of LPS-containing allergens twice a week for 4 weeks. To evaluate protective effects of FGF2, recombinant FGF2(10 μg) was injected subcutaneously during allergen challenge in the severe asthma model. We found that non-eosinophilic inflammation and emphysema induced by transgenic overexpression of IFN-γ in the airways were aggravated by the absence of FGF2. Airway challenge with LPS-containing allergens induced more inflammation in mice sensitized with LPS-containing allergens compared to challenge with allergens alone. In addition, LPS-induced lung inflammation and emphysema depended on IFN-γ but not on IL-13. Interestingly, emphysema in the severe asthma model was significantly inhibited by treatment with recombinant FGF2 during allergen challenge, whereas lung inflammation was unaffected. Therefore, our present data suggest that FGF2 may help protect against IFN-γ-induced emphysema, and that recombinant FGF2 may help lessen the severity of emphysema.